A Trend-setter in the Healthcare Architecture World
Prof. (Dr.) R. Chandrashekhar
Advisor (Architecture) with HLL Lifecare Ltd. (A Govt. of India Enterprise)
Consultant …World Bank & Former Chief Architect with Central Design Bureau for Medical and Health Buildings, Ministry of Health & F W ,Govt. of India
As we know you have a vast experience in healthcare architecture you have done a lot of designing projects on served countries as a chief architect to ministry health government of India according to you please define ideal hospital?
Ideal hospital gets defined differently for different people such as for a poor patient an ideal hospital is different than rich and a affordable person but being an architect that too a Healthcare architect an ideal hospital should have a comprehensive approach in terms of planning i.e. planning parameter should include the Infrastructure, medical equipments and the human resources i.e. the manpower. This is the first step of ideal hospital, second as an architect or a promoter when he starts working on a hospitals feasibility project, the importance is given to its
Location i.e. whether the proposed site is in a flood prone or tsunami prone or volcanic eruption or earthquake prone or what kind of a zone it is so that he is taking proper precaution at the planning stage. then comes
Master planning presently you may have limited fund but your vision should be very clear so that the complete master planning of that plot and its potential usage is been planned and you have already envisage the future growth which we generally show it in a dotted line in an our plan so that the modular development and modules are getting constructed as per the need and it also gives respect to the upcoming new technological changes, thus when the master plan is done you are making sure that the circulations are well defined that is in terms of patient movement staff movement and if it is medical institution like medical college etc.. The student movement and at the same time the segregation of support services for the hospital as an independent movement. Emergency care is always 24*7 so that is taken care independently. These are the key aspects of circulation in the master planning or the layout planning then comes
Macro planning which relates to interdepartmental relationship and functional relationship so that it becomes very clear that what is your requirement for the entire hospital which you have envisaged, and Planning brief is properly made which is shared with the architect and you also define the Stacking.. Stacking is defining the facilities floor by floor. e.g. ground floor we have OPD or upper floor the operation theatres or ICU . then comes
Micro planning in which we are trying to see each department in detail and its relationship and independently each department’s future growth too. In a multi speciality hospital where you have speciality like cardiology cardiac surgery, neurology neurosurgery, nephrology urology, etc.. like many other speciality, then it must be ensured that while stacking speciality floor wise, you have to take care that their OPD and their IPD and the faculty area are planned at same floor so that minimum travel distance of clinician and staff will ease out efficiency of the hospital. Highly service intensive area such as the OT, ICU and HDU are planned in one floor because the floor heights also vary generally we keep say 3.6 meter floor to floor height for other areas but when it comes to the operation theatre area we don’t keep less than 4.5 meter due to specialised air conditioning systems and other services. A service floor above OT and ICU area helps accommodating AHU (Air Handling Units) and all services and above, you can have all your residential unit such as wards etc.. So that all the services like shaft for toilet etc… can be terminated in service floor.
The other important aspect is IAQ (Indoor Air Quality) with H1N1 and Swine flu alerting you and the recent Delhi pollution has sensitised everyone about Air Quality. At the same time Doctors are concern with HAI (Hospital Acquired Infection) .Proper HVAC system with not only trapping the Pathogens thru filtration, but killing the same thru latest technologies by using UVGI ( Ultra Voilet Germicidal Irradiation) or using PHI ( Photo Hydro Ionisation) techniques in HVAC system
Shortage of Hospital Space and manpower can be resolved only thru adopting use of Technology to bridge this gap. Thanks to our new government where they have promoted the digitization to a greater extent and because of that lot of things get sorted out by virtue of getting into digitization whether it is crowd management, be it parking or OPD scheduling or uses of diagnostics equipment, registration system, the laboratory system or even the operation theatre scheduling and integration of operation theatre where the consultants are consulted through technology through video conferencing and their specialized inputs are taken and that becomes a real saving of a manpower as well as time and not comprising on the quality of care.
Safety, besides our standard operating procedure (SOP) like hand washing and infection control parameters The biggest challenge is safety from Structural & Non structural members like false- ceiling, AC duct, plumbing line etc… during disaster like Earth quake if they collapsed how can you evacuate the patient needs to be of great concern while planning.
Infection Control parameters to be taken care at planning stage. we have also noticed that copper is anti microbial and it kills the bacteria itself so use of copper is ideal in terms of doors hardware like hand rail or door knob or even the grab bar in the toilet where 80 percent infections happens due to touch surface and the touch surfaces if are made of copper that will be a great resource in reduction in infection. Recently even pillow cover, bed sheets, curtains and hospital linen imbibing copper in the fabric plays major role. we can always use this kind of technology and methodology because time has come that people want safety and an infection free hospital including the clinician as well as the staff working in them.
Evidence Based Design what is evidence based design? It is Healing architecture, creating an environment to the patient that helps in healing rather over dosing a patient with anti-biotic. It is best achieved bringing abundant Natural lights in the environment. Researcher have researched to an extent that light on the west side versus the eastern side and reduction in average length of stay of patient and also helped in Pain management.
Design the hospital which is, patient centric, staff centric with healing environment and proper standard operating procedure and giving an environment with indoor air quality and indoor environment quality, This is what will be called Ideal Hospital
What are the salient feature of Green hospital according to you?
Answer – As you are aware that I am a chairperson of IGBC ( Indian Green Building Council) Healthcare Rating. IGBC have developed a exclusive healthcare rating which is first of its kind in the entire Asia which was released last year is available in IGBC website(www.igbc.in). Even the international standard does not have exclusive green rating for Healthcare. Nowadays even in the government of India we are asking minimum gold rating of IGBC or three star GRIHA rating these are very important
GRIHA is Green Rating for Integrated Habitant Assessment and IGBC is Indian Green Building Council and they also follow the ECBC which is Energy Conservation Building Code and similarly the environment protection you have to get an environment clearance etc.. These all relates to when we talk about green.
Green is basically How you are trying to save the environment in terms save this planet. what Is important in a Green Hospital is firstly the protection of Indoor Environment Quality (IEQ) and well being in which we do the minimum fresh air ventilation then tobaccos smoke control then what we talk about is Healing architecture in terms of day spaces, connectivity with nature just now I explain to you that green landscape open spaces courtyards and surrounding area healing garden, sometimes even in the rooftop we have a healing garden if this is a multi story structure.
We keep the Site planning with the landscape and healing garden and nowadays we use colour psychology that also helps in a green.
Most importantly is the Acoustic design. if there is a noise then the patient may not be able to sleep well and if he doesn’t sleep well his parameter like blood pressure and other parameter may be upset so acoustic control is very important then ergonomics… the design of various spaces and the furniture’s are to be stress relieving, also some spaces which we create, just by doing a little creative painting it can be a great healer and use of all low emitting material in the usage of construction that is we call volatile organic compound VOC related issues. Air quality monitoring testing after occupancy .
I may create an infrastructure but end of the day I may not be getting the correct distinct, then we also have to take care of the sanitation and hygiene in which the solid waste management then your Bio-Medical waste management and then Infection control within the spaces which are very important then isolation rooms designs are very essentially taken care in a green hospital.
Sanitation design and cleaning practices what you follow. Sustainability comes only when anything which we design is continuously monitored, we may even follow automated solid waste management and organic waste management for a better performance.
Energy is one of the key issue. Hospital is the highest energy guzzler, so energy efficiency in a hospital is Key design issue hence all the material including air conditioning system using of LED lights etc.. are very important at the same time bring in as much as day light & natural light, utilisation of solar energy and solar panel using solar photovoltaic for creation of energy these are the key features in terms of saving energy and then comes the water conservation because today we have shortage of energy and at the same time we have a shortage of water, so what you do is Rain water harvesting which is essential, whether through roof or whether various means and efficient plumbing fixtures that will bring out the perfection. Dual plumbing system is one of the major saving of treated water, also waste water treatment and reuse of the same for irrigation, landscape and cooling tower etc… You will be able to see all these feature in our green healthcare rating which has been released by IGBC
So to sum up I can say in a green healthcare facility you have to rate the indoor environment, air quality and sanitation and hygiene then you have a energy efficiency , water conservation ,building material and resources so that they are all in green rated and then site selection, planning and innovation these are the key points on which your entire green hospital is adjudged.
How you will elaborate a smart hospital?
Smart Hospital is a type of hospital that is able to share that domain knowledge with the same or other domain and fulfil the requirement of the obsequies and persuasive computing environment. the objective of smart hospital is Patient Centric ,should be Staff Centric then it should be Hospital Centric, in the sense, it takes care of the facility and improve resource utilisation deficiency and financial performance. Innovation is using of various new technologies in which minimum manpower is required and technology take care of things. In short Hospital system which provides facilities that are : Specific,
Apart from Green and Sustainable design it will have Smart Patient Room, Smart clinician and Nurses with one gadget providing various information, Patient monitoring Smart device, various sensor based monitor system and E Hospital with emphasis on IT based solutions. Digital information and digital analytics also that is equivalent thought unified communication and integrated audio video and data to allow the seamless and secure communication, high speed reliable networking identification, building automated system, under Digital India, hospital will have digital governance.
I believe the smart hospital in the smart city not only in the smart city it has already started in many of the corporate level hospital and even in the government hospital, the smartness is going step by step right from crowd management, the IT’s usage for the one time identification number like Aadhar is been linked with everyone so that validated data will be available in a common way with anybody using the portal they can use the data of a person to save him from any fatality. so we have already taken a step towards smart hospital but in a primitive stage , seeing very futuristic, smart hospital to be part of our countries smart cities which are upcoming.
What are the major role of a healthcare consultant?
As you are aware that Ministry of Health, Government of India is investing in a big way in improvement of healthcare infrastructure particularly under the PMSSY that is Pradhanmantri Swasthya Suraksha Yojana wherein they have already set up six AIIMS like institution and setting up six more AIIMS like institution and many more to come and to support to the cause with the faculty etc.. They have a parallel scheme of up gradation of existing State Govt. medical colleges with super speciality blocks where they add more post graduate seats and these PG students become the future faculty for the upcoming AIIMS and very good healthcare consultant only can fulfil GOI’s dream if the buildings are planned well as I stated about the ideal hospital earlier. Unless these parameters are considered, it becomes very-very problematic. Since Healthcare architecture is little different than the regular architecture because in this you have to account for three major component that is Infrastructure alongwith its Medical equipment and the Manpower unless these are not dovetailed together you may build a huge infrastructure and there is not enough equipment or the equipment planning is not dovetailed, you may find there is not enough space available for certain equipment when it arrives and at the same time you are not aware of the equipment details, hence the planning parameter gets upset and sometimes you may have to break the constructed wall or maybe rearrange the electrical power supply or air conditioning system. Hence comprehensive planning is key factor, so consultant should be knowledgeable and experienced in such approach to the planning.
In India shortage of availability of trained Medical Architect was felt and that is the reason we have developed a master’s program for health facility planning and design and the course structure is ready which is approved but somehow due to some of the operational methodology etc.. the course is getting delayed but there are certain private institution who are willing to take up the course. Trained medical architect is the need of the hour , he as a professional to take care of the healthcare architecture because the hospital is highly service intensive where you have to have a knowledge of a specialize air-conditioning and specialize electrical planning, medical gases and modular Operation theatre and integrated theatre these are the key parameter he should be knowledgeable and once he is knowledgeable he will be planning the structural grid accordingly which will have the flexibility in planning. He will also be able to take the challenging remodelling of Existing hospital without disturbing the functioning of existing hospital.
when I took over this and trained myself abroad, as you are aware I m the first PhD in the field of medical architecture in India, I felt the need of this subject very badly that is the reason we developed the course structure and similarly we also require trained healthcare engineers. Hospital construction and maintenance is much different than the any other building.
How you are connected to the healthcare world after your retirement?
Healthcare is my passion which motivates me to leap ahead. During my 32 years of rich experience in the Ministry of Health, all my seniors and my supporters were always motivated me to carry a step ahead that is how you see me today much busier during my post retirement by virtue of offering my services to various people besides my ministry, where I do some of the advisory roles and also to their PSU and various practicing architects who are interested into healthcare and they take my services and I am consulting to World Bank and also some of the peer review consultancy for some of the private institutions, corporate sector and also some of the institutions abroad. As academician I am visiting faculty in various Institutes, sharing experience& knowledge in Conferences and workshops and also highlighting effort of government of India in various forum ,but I know that lot needs to be done but it is always the effort of every individual that matters and I am doing my bit to serve the community because this is the time to give back to the society.
As we know the air pollution is increasing day by day and it is a cause of many more diseases also so what is the role of air purifier indeed?
Whenever any problem is highlighted, immediately various companies tries to commercialize some products as an answer, in the process at least some good results are also forthcoming. I am a chief advisor with one company which is called Air Indoor assessment private ltd. it does only the indoor air quality audit of Hospitals, Institutions even residences, and suggests various corrective remedies without recommending or promoting any particular commercial brand. Thru media various sensitisation programmes are done, one has to remember these are the temporary corrective measure for short term. what we have to work towards is the root cause such as how you improve the infrastructure, how you make a public transport so viable so that people will not take car out . These are the some of the things which is to be recognized and I do agree it’s a great challenge in a very heavily populated area, and to undertake this, you need to have a proper professional study and the implementation process. Just by putting a mask or respirator or even buying some machines and trying to analyze your room air quality are few measures which can take care temporarily but core problem needs to be addressed.
What is expert advice to the promoter or owner of the hospital while designing healthcare facility?
Yes this is actually a summary of my talk today like in the initial stage I said a promoter or a owner of a hospital always interested in a feasibility study. As explained about ideal hospital, he has to take note of all aspect as stated. Whether it is government or private or corporate hospital, the focus is faster turnover of patient .In the case of promoters he expects faster return on investment. I would also advice that they should get into the PPP schemes i.e. Public private partnership ,so the huge amount of investment in terms of Medical Equipment is not with the promoter or the owner. He provides the space in his building and he can do PPP with some diagnostic equipment company so that the equipment is purchased or brought by the company and only they do the revenue sharing which we call it wet leasing that means promoter gives you the space and Medical Equipment co. runs the activity. Each get their agreed share.. Thus Go Green.. patient should be the focus, technology should be the key so that will make a efficient hospital and will also join the wagon of smartness.