Assoc' Prof' Datin Ar' Norwina Mohd Nawawi

1
Hospital Design a brief insight on the
development of hospitals in Malaysia in
comparison to projects overseas

• Presented by
• Assoc. Prof. Datin Ar. Norwina Mohd Nawawi
• International Islamic University Malaysia

2
Outline

• Introduction
• Healthcare
• Hospital Architecture
• Development of Hospital Abroad
• Malaysian Healthcare Services
• Development of Malaysian Hospitals pre and post
  independence
• Current issues in hospital development
• Summary

3
Introduction

• Healthcare and Hospital Architecture

4
Introduction

• Health care presents a different problem in
  every country for the way it is organised is a
  response to geography, climate, historical
  development, economic situation and social,
  cultural and political conditions
• Appreciation of these differences is fundamental
  to understanding of the situation which prevails
  in a country.

Anthony Cox, Philip Groves.1990. Hospitals and
Healthcare Facilities. Gt.Britain.Butterworth
Co.
5
Definition on Health

• Health is a state of complete physical,
  mental, and social well-being and not merely the
  absence of disease or infirmity
• W.H.O.
•  
• Health, as we define it today, is a state of
  complete physical, psychological, social and
  spiritual well being.
• 
  Islamic worldview

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

• Essential health care based on practical,
  scientifically sound and socially acceptable
  methods and technologies made universally
  accessible to individuals and families in the
  community through their full participation and at
  a cost that the community and country can afford
  to maintain at every stage of their development
  in the spirit of self-reliance and self
  determination
• The Declaration of Alma Ata in 1978

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Health Pyramid

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

Tertiary
Secondary
Primary
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The Level of Care

• Primary care embraces all the general health
  practices, educational, preventive and curative,
  that are offered to the population at the point
  of entry into the System.
• Secondary Care comprises the care provided by
  more specialised services to which people are
  rendered by the primary care services.
• Tertiary Care includes highly specialised
  services not normally found at secondary level,
  including super-specialities such plastic
  surgery, neurosurgery and heart surgery.

Anthony Cox, Philip Groves.1990. Hospitals and
Healthcare Facilities. Gt.Britain.Butterworth
Co.
9
Principle of Referral of Patients

• The principle of referral of patients from a
  lower level of care to a higher level as a method
  of sorting them according to their need for
  specialist diagnosis or the nature or the degree
  or their disabilities is also universally
  recognised.
• Another is aim to work in both direction for
  which the reverse is meant for convalescence.

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PRIMARY CARE

• At this level, health care services are based in
  the community and relatively accessible to
  patients and their families they are also
  located at the periphery of the system.
• The services include preventive health measures
  such as immunisation programme, ante-natal and
  child care and simple diagnosis and treatment.

Anthony Cox, Philip Groves.1990. Hospitals and
Healthcare Facilities. Gt.Britain.Butterworth
Co.
11
PRIMARY CARE

• They are operated by doctors,nurses,medical
  auxiliaries and social workers based in aid
  posts, dispensaries, clinics and health centres
  that serves relatively small numbers of people
  and situated as close as possible to their homes.
  This will enable medical and other health
  personnel to be in contact with their patients
  habitual environment.
• In a more urban environment, primary care is
  provided by a group of general medical
  practitioners.

Anthony Cox, Philip Groves.1990. Hospitals and
Healthcare Facilities. Gt.Britain.Butterworth
Co.
12
SECONDARY CARE

• At this level, there is general hospital to which
  patients from wide surrounding area are referred
  to whenever necessary by primary care units for
  more sophisticated diagnosis or treatment.
• Although expensive, hospitals are indispensable
  part of the health care provision as there will
  always be a proportion of patients who need the
  particular skills and equipment that can be
  concentrated in them as well as being centres for
  medical and health education ..and research.

Anthony Cox, Philip Groves.1990. Hospitals and
Healthcare Facilities. Gt.Britain.Butterworth
Co.
13
SECONDARY CARE

• Thus referral to hospital is essential for
  special diagnosis and treatment as outpatients
  where possible and only to be admitted when the
  degree of care is necessary for recovery.
• Location of this facility is normally further
  away from their homes

Proposed Ampang Hospital
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TERTIARY CARE

• Tertiary care are healthcare services that deals
  in teaching of medicine i.e. the teaching
  hospitals as well as specialised institution such
  as the Cardio Thoracic Centre, The Spinal Centre.
  
• Tertiary care include research activities that
  benefit the other level of care.

HKL
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TERMINAL CARE

• Terminal care or hospice care or palliative care
  means
• care or the terminally ill person that addresses
  the physical, psychological. Emotional and social
  needs of the person or his family.

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Spectrum of healthcare

• These are again refined to PROMOTIVE, PREVENTIVE,
  CURATIVE,REHABILITATIVE and PALLIATIVE care.

preventive
Palliative
Promotive
Curative
Rehabilitative
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The referral system

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

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Health-care facilities

• Healthcare impels the provision of a wide variety
  of buildings, to serve many different functions
  and accommodate the whole life span of man.
• From cradle to grave
• From Womb to Tomb
• Shelter is needed for the promotion of health and
  the prevention of sickness, for assisting natural
  functions like childbirth, for curing
  disabilities and repairing malfunctions and for
  supporting the afflicted and incapacitated.

Healthcare buildings as defined by Cox.A et al
(1981)
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Health-care facilities

• This shelter may fall into a number of generic
  types. Although medical knowledge is largely
  international, the ways in which it is applied
  and in which it is delivered in one country and
  another are likely to differ, as are the forms of
  building appropriate to the particular
  circumstances.
• The forms reflect the nature of the organisation,
  culture, economy and geography of their
  respective situation and the peculiarities of
  their social microclimate.

Healthcare buildings as defined by Cox.A et al
(1981)
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Health-care facilities

• There are no universal solution for the provision
  of healthcare facilities.
• It is dangerous to generalise but it is
  reasonable to make a broad distinction between
  the facilities available or provided for between
  the developed and the developing world.

Healthcare buildings as defined by Cox.A et al
(1981)
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Building typology

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

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Hospital Architecture

• As a building typology

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Hospital Architecture

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

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Hospital Architecture

• The emergence of hospitals with all its
  technicalities, do not exclude the fundamental of
  good architecture in addressing the environment,
  culture, needs and definitely the clinical
  requirements for the very purpose of treating and
  saving lives for all.

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Hospital Architecture

• Throughout the hospital developmental history,
  hospital buildings plays a significant role in
  considering the people they house and shelter to
  get well are not infected by the very convergence
  of all the sickness they harbour at the
  inception.

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• Functional requirement that include critical
  planning to work flow, operational policies,
  clinical procedures and infection control plays a
  fundamental role in determining the success of
  the facility

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Brief history

• Hospitals began with a humble beginning of
  charitable organization for the poor, the
  sanatorium for the mentally ill, the hospices for
  the terminally ill, religious buildings and make
  shift buildings during the early wars

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Brief history

• On passive design considerations, the Greeks,
  through Aesculepius, invented spas and gardens
  with fresh air, sunlight, music and places for
  relaxation as a mean of healing.

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HD,04

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

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• Good environment plays an important role in
  recuperating back the health well-being of
  patients, in the Muslim history of healthcare
  during the Ayubbid, the Andalusian and Ottoman
  period, based on the ayah,
• You shall not attain to virtue unless you
  spend (for the welfare of the poor) from the
  choicest part of your wealth. 392,
• hospitals or Bimaristan were converted from
  palaces apart from purpose built structures of
  the kulliyye or mosque cum madrasa complexes.

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

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• If all forms of the Islamic worship are
  carefully examined, principles of public health
  and hygiene, which is the most important
  objective of medical science, have been kept in
  view with attention to the minutest details.
• There were even reports that when Adudi hospital
  was set up in Baghdad in 982 AD by Buyid Adud
  al-Daula near the bank of Tigris river, several
  meat was hanged for a few days at the proposed
  site. The site where the meat was least infected
  were eventually chosen for the construction of
  the proposed hospital.

Internet hospital in Islam Excerpted from
English translation of Dr. Sibai's book "Min
Rawa-i-Hazaratuna" by S.A. Khan.
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Hospital basic components
Non Medical Support
Outpatient
Diagnostic and Treatment
Administration
Inpatient Area
Training
Medical Support
Research
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Basic Hospital Forms and Configurations

• Pavilion / Village Concept
• Finger Like
• Town / Tower and podium Concept
• Compact
• Doughnut
• The Mall
• Other

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Pavilion / Village Concept
 
Individually designed pavilion or standard
templates
 
Open ended corridor for flexibilty
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Tower Podium
tower
               
podium
Compact
   
Where all the departments are stack up and put
together in one whole structure
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Finger like
Doughnut/ Courtyard