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2018

SYEDA SAMEEHA MARYAM


14131AA039
7TH SEMESTER
D.S.P.A

[PRE THESIS SEMINAR]


A BIOPHILLIC MULTISPECIALTY HOSPITAL
BIOPHILLIC HOSPITAL
1. SYNOPSIS
1.1 AIM
To design a 200 bedded multispecialty hospital which can meet all the present
demands of healthcare institutes providing best medical cure adopting the
concept of Biophillia.

“Can good architecture alleviate the suffering of psychiatry patients and their
families? Can it speed recovery and thus be said to enhance the efficacy of care?”
With these questions in mind, creating a welcoming and caring environment that
treats the facility’s design as an element of patient care is necessary. The new
facility is to design the campus that delivers somatic care, helping to reduce the
stigma and isolation of mental illnesses. Nature should be the influence
throughout the facility as access to nature has been shown to have positive
effects on health and wellbeing.

The main aim is to design to a healing environment and to support connections


with nature, all while adhering to the unique safety and security needs of a
psychiatric facility.

Staff must be able to monitor patients, and to ensure their safety in the facility.
Access to outdoor spaces while still adhering to the safety requirements.

1.2 OBJECTIVES
General objectives Design related objectives
1.To take step forward and meet present 1. To study circulation pattern and traffic
demands in healthcare institutes in the flow of users and machines.
country
2. To spread awareness about the need of 2. To study inter relation of various
energy efficient and functional buildings. departments.

3.Creating and encouraging Biophillic 3.To study services in detail


concept in designs.

1.3 INTRODUCTION TO TOPIC


Hospitals play an important role in the health care systems. They are called
the healthcare institutions that have organized medical and other
professional staff and impatient facilities and deliver medical, nursing and
related survices 24 hours per day and 7 days per week.

The basic purpose of a hospital is providing the treatment & care of the sick
& injury patient.
The functions of a hospital are given below:-
1 Patient care:- patient care involves diagnosis, treatment of illness or
injury preventive medicine, rehabilitation, convalescent care, dental care,
personalized services

2 Education services: - The education services are two form:-


a) Medical & allied health profession education: - Teaching of
physician nurses, pharmacist, medical technologist, medical social
service worker, hospital administration & training, dietician etc.
b) Patient education: - children, general education, social education for
rehabilitation health care & also patient counseling.

3. Research: - Research is important to advanced medical knowledge


against disease & to improve hospital service. This is important for better
health care of patient.

4. Public health care: - public health is important to assist the community


to reduce chance of illness & to improve general health population.

Definition of Hospital WHO Expert Committee, 1963: ‘A hospital is a


residential establishment which provides short-term and long-term medical
care consisting of observational, diagnostic, therapeutic and rehabilitative
services for persons suffering or suspected to be suffering from a disease
or injury and for parturients. It may or may not also provide services for
ambulatory patients on an out-patient basis
WHO expert committee, 1956: ‘The hospital is an integral part of a social and
medical organization, the function of which is to provide for the population
complete healthcare, both curative and preventive, and whose out- patient
services reach out to the family in its home environment; the hospital is
also a centre for the training of health workers and for bio- social research’’
1. Hospital Function 1. Intramural: Services within the wall of hospital 2.
Extramural: Services outside the wall of hospital. eg, OPD, Outreach
services, Medical Camps, Immunization Program
2. 18. The Rehabilitation Services are dedicated to providing high quality,
individualized, and effective interventions aimed at promoting both patient
safety and a return to
independent function. Services
include Physical Therapy,
Occupational Therapy, and
Speech-Language therapy etc
with compassion and empathy
in a patient and family centered
care environment.
3. 19. The provision of basic
health services in Bangladesh
is a constitutional obligation of
the Government. Article 15 of
the Constitution stipulates that
it shall be a fundamental
responsibility of the State to secure for its citizens the provision of the basic
necessities of life, including food, clothing, shelter, education and medical
care. In addition, Article 18 of the Constitution asserts that the State shall
raise the level of nutrition of its population and improve public health as
some of its primary duties

CONCEPT OF BIOPHILLIC DESIGN


Biophilic design is the deliberate attempt to translate an understanding of
the inherent human affinity to affiliate with natural systems and processes-
known as biophilia (V'Tilson 1984, Kellert and Wilson 1993) - into the
design of the built environment. This relatively straightforward objective is,
however, extraordinarily difficult to achieve, given both the limitations of our
understanding of the biology of the human inclination to attach value to
natUre, and the limitations of our ability to transfer this understanding into
specific approaches for designing the built environment.

As noted, biophilia is the inherent human inclination to affiliate with natural


systems and processes, especially life and life-like features of the
nonhuman environment. This tendency became biologically encoded
because it proved instrumental in enhancing human physical, emotional,
and intellectual fitness during the long course of human evolution. People's
dependence on contact with nature reflects the reality of having evolved in
a largely natural, not artificial or constructed, world. In other words, the
evolutionary context for the development of the human mind and body was
a mainly sensory world dominated by critical environmental features such
as light, sound, odor, wind, weather, water, vegetation, animals, and
landscapes.

The two basic dimensions of biophilic design can be related to six biophilic
design elements:

• Environmental features

• Natural shapes and forms

• Light and space

• Place-based relationships

• Evolved human-nature relationships

Environmental features:
1. Color
2. Water
3. Air
4. Sunlight
5. Plants
6. Animals
7. Natural materials
8. Views and vistas
9. Facade Greening

Natural shapes and forms


1. Botanical motifs
2. Tree and columnar supports
3. Shells and spirals
4. Egg, oval, and tubular forms
5. Arches, vaults, domes.
6. Shapes resisting straight lines and right angles

Natural patterns and processes


1. Growth and effiorescence.
2. Central focal point
3. Integration of pans to wholes.
4. Fractals

Light and Space


1. Natural light.
2. Filtered and diffused light.
3. Light and shadow.
4. Reflected light.
5. Light pools.
6. Inside-outside spaces.
7. Spaciousness.
8. Space as shape and form.

Place-Based Relationships
1. Geographic connection to place
2. Cultural connection to place
3. Landscape features that define building form.
Evolved Human-Nature Relationship
1. Security and protection.

CONCLUSION
This objective is refashioning of nature to satisfy human needs, but in ways
that celebrate the integrity and utility of the natural world. Thus, human
intervention, if practiced with restraint and respect, can avoid arrogance
and' environmental degradation. With humility and understanding, effective
biophilic design can potentially enrich both nature and humanity.
2. Literature
2.1 Classification of hospitals
There are many methods of classification of the hospitals, such as;

1. According to the level of care: a. Secondary hospitals; District Hospital


and some of Specific Hospitals. b. Tertiary hospitals; Central High
Specialized Hospital, Educational Hospital and some of Specific Hospitals.

2. According to the size of the hospital: a. Mini size hospital; <50 bed. b.
Mid-size hospital; 50-250 beds. c. Big hospital; 250-500 bed. d. Huge
hospital; >500 bed. 3. According to the size of the medical specialists: a.
Specialist hospital; pediatric hospital, eye hospital.. etc. b. General hospital;
all medical specialists are provided. d. According to the owners of the
hospital: a. Private hospitals. b. Public hospitals; university hospitals, etc.

2.2 Elements and divisions of the hospital


The main division of the hospitals are:

1. Administration division.

2. Outpatients’ division, includes; • Outpatient clinics. • Pharmacy. •


Emergency reception.

3. Diagnostic services division, includes; • Laboratories. • Radiology


(diagnostic).

4. Therapeutic services division, includes; • Physical Therapy. • Radiology


(therapeutic).

5. Internal medical treatment division, includes; • Operation Theatres. •


Intensive Care unit. • Maternity section. • Central Sterilization Department.

6. Inpatient division, includes; • Patient wards. • Nurses wards. • Inpatient


services
7. General service division, includes; • Kitchen. • Laundry. • Storages. •
Workshops. • Mechanical services. • Mortuary. • Security. • Parking. •
Landscaping

Administration division
Parts and components

1. Reception hall
2. Waiting area
3. Registration
4. Treasury and accounts
5. Staff offices
6. General manager office
7. Staff lounge
8. Nursing head office
9. WCs.
Location

•Very close to main entrance of the hospital.

• Entrance area, registration, accounts should face the entrance, while the
manager office should be back for privacy.

Area of the department:

• 50 bed hospital area = 214 m2

• 100 bed hospital area = 363 m2

• 200 bed hospital area = 567 m2

Outpatient Division
Part and components

1. Consultation room
2. Examination room
3. Treatment room
4. Waiting area
5. Staff area
6. WCs.

Location:

• Very close to the main entrance of the hospital.

• Close to the diagnostic services (labs and x-ray).

• Close to the pharmacy.

Area of the department:

• 50 bed hospital area = 215 m2

• 100 bed hospital area = 350 m2

• 200 bed hospital area = 540 m2


Emergency Reception
1. Entrance and waiting area
2. Registrations
3. Staff room
4. Mini surgery
5. Test room
6. Medical utilities
7. Mini sterilization

Location:

• Very close to the exit door of


the emergency.

• Very close to the radiology.

• Close to the pharmacy,


laboratories, and central
sterilization.

• Direct access to the stairs and elevators.

Area of the department:

• 100 bed hospital area = 100 m2

• 200 bed hospital area = 215 m2

Diagnostic services division


Labs

Parts and components:

1. Workarea
2. Waiting room
3. Sample room
4. Cleaning room
5. Staff offices
The most important labs in the
hospital are

1. Chemical lab
2. Bacteriology lab
3. Hystologyg lab
4. Pathology lab
5. Serology lab
6. Hematology lab
7. Micro bilology lab

Location

• Very close to the emergency department and external clinics.

• Easily accessible from internal division.

• Easily accessible from maternity and surgery departments.

• Accessibility from central storages.

Area of the department

• 50 bed hospital area = 25 m2

• 100 bed hospital area = 60 m2

• 200 bed hospital area = 103 m2

Or area can be counted by the number of the beds, 0.7-0.8 m2 / bed.

Radiology division
Parts and components

1. X-ray rooms
2. Control room.
3. Waiting area.
4. Staff office
5. Utility room.
6. Dark room.
7. Film view.
8. Store.

Location:

• Very close to the emergency


department and external clinics.

• Easily accessible from internal


division.

• Ground floor is preferred.

Area of the department:

• 50-100 bed hospital area = 65-104 m2

• 200 bed hospital area = 220-240 m2

Therapeutic services division


Physical therapy division:

Parts and components of the division:

1. Waiting area.
2. Office.
3. Hydrotherapy.
4. Exercise room.
5. WCs.

Location:

• Close to the main entrance of the hospital.

• Easy accessible from external clinics.

• Easy accessible from internal division.

• Must be in the ground floor.


Area of the department

• 50-100 bed hospital area = 65-104 m2

• 200 bed hospital area = 155-225 m2

Internal medical treatment division


Operation theatre:

Parts and components of the division:

1. Entrance.
2. Storage.
3. Preparation room.
4. Access area
5. Staff clothes room WCs.
6. Operation theatre.
7. Cleanup room
8. Sub sterilizing room.
9. Supervision room.
10. Staff lockers.

Location:

• Very close to the intensive care division and should be touchable both of
them.

• Very close to the central sterilization division of the hospital.

• Close to the inpatient wards.

• Can be easily accessible from the emergency division.

Area of the department:

• 50 bed hospital area = 185 m2

• 100 bed hospital area = 360 m2


• 200 bed hospital area = 550 m2

Intensive care unit


Parts and components of the division:

1. I.C.U space.

Location:

• Very close to the recovery room in


the operation theatre.

• Can be easily accessible from the


emergency division by elevator.

Area of the department: Must be


designed 1-2 % of hospital beds.

Maternity division:
Parts and components of the division:

1. Open room. 20-40 m2


2. Operation. 26 m2
3. WCs.
4. Utilities. 8 m2
5. Office. 15 m2
6. Unclean room. 8 m2
7. Cleanup room. 5 m2
8. Storage. 10 m2
9. Waiting area. 10 m2
10. Corridors w = 2.2 m

Central sterilization
division:
Parts and components of the
division:

1. Work space.
2. Receiving area.
3. Washing area.
4. Supplies storage.
5. Location:
6. Very close to the operation theatre and maternity division.
7. Can be easily accessible from the emergency division, laundry and
central storages.

Area of the department

• 100 bed hospital area = 65 m2

• 200 bed hospital area = 110 m2 Or 0.6-0.9 m2/bed, 0.6 m2 for large
hospitals and 0.9 m2 for small hospitals.

Inpatient division
Parts and components of the division:

1. Inpatient wards. 11.5m2/bed – 8m2/bed.


2. WCs.
3. Nursing station. Not less than 12m2 for 30 patients.
4. Treatment rooms. 10-15m2 for 60 patients
5. Day rooms. 0.7m2/bed and not less than 15m2 • Nurses’ lounge. Not
less than 12m2
6. Storage. 8-12m2 • Kitchen. 12m2
7. Doctor room. 15m2
8. The most suitable beds in the hospital is 20-40 patient / unit.
General service division
Dietary division:

Spaces of the division:

1. Storage room.
2. Kitchen.
3. Preparing and supply area.
4. Cleaning.

Location:
• In the ground floor.

• Direct opening to the service entrance.

Area of the department:

• 100 bed hospital area = 195 m2

• 200 bed hospital area = 355 m2

Housekeeping division
Spaces of the division:

1. Office.
2. Dirty linen.
3. Clean linen.
4. Storage.
5. Laundry.
6. Mechanical room.

Location:

• In the ground floor.

• Close to central storages.

Area of the department


 50 bed hospital area = 150
m2
 100 bed hospital area = 180
m2
 200 bed hospital area = 270
m2

General Storages:
Spaces of the division:

1. Medicine storage.
2. Furniture storage.
3. Food storage.
4. Utilities storage.
5. Achieve.
6. General storages.

Location:

• In the ground floor.

• Close to housekeeping and dietary division.

• Direct access to the service entrance.

Area of the department:

• 100 bed hospital area = 260 m2

• 200 bed hospital area = 520 m2

Generally the area of the storages is 2-2.6m2 /bed

Mortuary division:
Location:

• In the ground floor or basement floor.

• Exit from emergency entrance or service entrance.


Area of the department:

• 50 bed hospital area = 25 m2

• 100 bed hospital area = 45 m2

• 200 bed hospital area = 70 m

Maintenance workshops:
Location:

• In the ground floor or basement floor.

• Direct relation with service entrance.

Area of the department:

• 50 bed hospital area = 65 m2

• 100 bed hospital area = 90 m2

Entrances and circulation Entrances:


1. Patient visitors entrance.
2. External clinics entrance.
3. Emergency entrance.
4. Service entrance.
5. Mortuary entrance.

2.3 CIRCULATION
It is said that hospital planning start from circulation .In the word of
Emerson Goble,“Separate all departments, yet keep them all close
together, Separate types of Traffic, yet save steps for everybody,that’s all
there is to hospital planning”.

Thus the different type of traffic of traversing the buildings shouldshow


planned so as to avoid inter-mixing of functions there by keeping them as
short as possible as “time” is an also important aspect. The main aim while
caring for the sick is to prevent cross infection, maintain asepsis of highest
order and ensure ease of movement for patients and supplies. Therefore,
all movements need to be well planned in advance to facilitate ease for
function and asepsis maintained.

The traffic in Hospital constitutes of five main streams:

• Out patients

• In patients

• Visitors

• Staff, and

• Supplies

And for their functional interrelation, it is necessary to know well as to


where they circulate. Throughout the planning, traffic requires careful
thought. Besides, the various complicated lines of traffic within the hospital,
traffic to and from the hospital must be given consideration. To be able to
regulate traffic within the building, we should start by regulating it first on
the outside of the building.

External Traffic

• Patients – arriving or leaving by foot or by vehicle

• Visitors

• Staff members

• Delivery of incoming supply

• Removal of dead

• Delivery of removal and removal of refuse

• Out patient’s traffic.

Internal traffic

• Incoming patients – from x-ray, admission etc.


• Outgoing patients

• Inter–departmental traffic

• Deceased patients

• Visitors

• Staff members

• Out patients – enroute to laboratory, x-ray, therapy etc.

• Non – medical employee

• Food supply and waste

All these elements, comprising the traffic in a hospital and their typical line
of circulation shall be related as such as allow free and unobstructed
movement to each one of them.

In the design process, circulation being the principle subject for study, it
involves the proper investigation of the many departments so that different
types of traffic through the building will be separated as much as possible,
traffic routes will be short and important functions protected against
intrusion. Circulation will determine the efficiency of the hospital for all the
years of its use.

PRIMARY PRINCIPAL OF CIRCULATION SCHEME

• Protection of the patient is the primary principle of circulation scheme. Too


much traffic in the nursing corridor will disturb the patient; will involve
excessive risk of contamination, or at least of confused and inefficient area.
Any unwanted traffic in the surgical suite means dilution of the
effectiveness of aseptic technique. Assured protection against
contamination is the very heart of good patient care and the basis of
hospital planning.

• Short traffic routes, with as much separation as is feasible, assists in


assurance of asepsis. Obviously short routes save steps for everybody
concerned with hospital care. Nurses, doctors, patients, service and office
personnel, all have a share in the patient’s welfare. All must work fast at
times, and all are subject to fatigue.

Separation and segregation

It is a principal in which the separation of dissimilar activity likes clean and


dirty, quite and noisy, different type of patients/traffic etc help in better
functioning along with the prevention of infection, patient discomfort,
Accident, this segregation should also be incorporated out-side of building.
But care should be taken that too much of physical separation hamper
proper functioning of certain related activities

Control

Control is important general objective, in which the vast variety of traffic


that is on continues to-and-fro motion in the Hospital and its premises does
require strict and disciplined control. There need to be check over visitors
Entering patient Areas, sensitive patients, safety and security of patients,
Good supplies etc. All these calls for special safety measures with limited
Asses entry points under well supervision.

Separation of external traffic

It is necessary to separate the external traffic before getting into the


building. Usually, there are separate main traffic lines.

• Outpatients.

• Inpatients and visitors.

• Emergency patients (or ambulance cases).

• Supplier and fuel.

i. The main entrance would usually serve for ambulant inpatients, or leaving
after their stay. They proceed through main lobby to admitting desk and
then to his or her bed. Visitors also use the main entrance largely for
reason of control of visitor traffic by receptionist. The main entrance can
also be used by doctors, so that may be clocked in or out, or possibly so
that the records clerk may catch them for a task the doctors always seem
to find overused. On the other hand, doctors frequently prefer a separate
entrance so that they will not be buttonholed by the visitors or relatives or
just friends. Another consideration is that usually the doctors have a
separate parking area, and another entrance may be much more
convenient.

ii. Separate entrance is desirable for outpatients since any volume of them
would soon confuse the main entrance and the departments nearby.
Moreover, there is need to control the movements of outpatients, to keep
them out of principal corridors, to confine them to certain areas.

iii. The ambulance or emergency entrance- Is presumed to be convenient


for inpatients who must be brought in by ambulance or private car. The
emergency is principally intended, however, for real emergency cases, who
might Arrive in some unsightly condition and who would require instant
attention in the emergency suite. The emergency patient_ might even be
drunk, or criminal arriving with full escort. Also the emergency case might
be a medically dirty patient, not to be taken any farther than necessary until
he can be given some preparation.

iv. Parking space

It is usually grouped roughly According to entrances. At the least, there


should not be expected to fight a traffic jam at each visit. Perhaps, hospital
workers should have a separate parking area. Clearly, any separation that
can be arranged for parking areas will help to maintain separations of types
of traffic both within and without the building.

Internal traffic

Architects have developed notable integrity in schematics designed to


control traffic. The cruciform plan is an old favorite, providing a central
traffic and service core and a good number of cull de sac locations in the
wings. The T form is another favorite. Again, there is a central core, with
various medical departments isolated in bays of the T, floor by floor, and
nursing units facing south in the top of the T. Variations are found, literally
by the dozen, with wings added on to isolate departments, particularly on
the lower floors.

Sometimes, a wing is sent out, only to be folded back again against the
building.

Always the intent is to separate departments yet keep horizontal travel to a


minimum. It is worth noting, and quite healthful, that standard schemes do
not seem to do very well against the wide variety of individual conditions
and sites. And against the ever changing display of originally that architects
have exhibited.

CARE AREA

(INPATIENT NURSING UNIT)

WARD DESIGN: GENERAL

Outlooks on ward sizes subject rapid change. Main recent trend away from
classical ward types (eg

Nightingale: 12-B open ward with nurses desk at 1 end; Rigs: 24-B with
nursing room outside ward, beds set in clusters); preference now for2—4
B. Despite this strong preference still controversial: very small wards give
privacy and in theory more personal attention but can also be lonely, less
often visited; le society and staff supervision possibly better in larger ward.
Patients need audio and visual privacy during med visits. Background noise
and bed curtains provide some in large ward but lights disturb at night;
small wards peaceful for resting patient but do not provide audio-privacy.
Average stay in hospital for acute med or surgery has fallen, e.g.: major
surgery 10—12 days, minor 2—3 days, max 6 weeks (mainly orthopedic).
Wards for these purposes therefore designed for max efficiency of staff
working. For physically and mentally handicapped and elderly— long stay’
—ward design more domestic and social.

• Walking distance: keep walking distances short as possible for nurses


and ambulant patient. Max distance from bed to Wc 12 m and from nurse
working room to furthest bed approx 20 m.
• Observation: continuous observation of patient by staff essential part of
nursing care: during day achieved mainly in course of walking from 1 duty
to another, at night from nurses station. Good design aim: 50%of beds to
be visible from nurse’s station. Patients gain confidence from seeing staff at
work, dead-leg wards not popular for this reason. If staff have no duty
perform less likely visit ward.

• Control: patients, particularly children, adolescents and confused, need to


be controlled; dayr must not be too isolated from rest of ward. Mixed-sex
wards have own control problems. Staffs need to control visitors and check
that they do not overtire patients.

• Noise: problem in large open areas; telephones and other el and


mecheqp can be noisier than acceptable. Design for 40—45 dB by day and
35—40dB at night in multi-B wards; 1-B wards should be 35—40 dB at all
times. Courtyard designs can create problems of noise from adjacent
windows to different room.

• Daylight & glare: windows should not cause glare in bedfast patients’
eyes; beds should be parallel to windows unless brise-soleil, external or
between-glass blinds or similar devices fitted.

Windows design important: confused patients may try get out; all opening
lights should have device restricting accessible opening to 100.

• Ventilation: mechanical ventilation often noisy and unsatisfactory, full air-


conditioning expensive install and run. Normal sites away from air or traffic
noise should rely on natural ventilation; 3 beds deep from window max
before mechanical ventilation required. Central work rooms require
mechanical ventilation and suffer from heat build-up in summer.

• Nurse call systems, closed circuit television (CCTV): Devices ofvarious


grades of sophistication; all liable to abuse or failure. Seriously ill patients
cannot operate call systems therefore unwise rely on these rather than
personal observation; acceptable as auxiliary system.

Inpatient nursing units, that is, ward concept is fast changing due to policy
of early ambulation and in fact only a few patients really need to be in the
bed. The basic considerations in placement wards is to ensure sufficient
nursing care, locating them according to the needs of treatment, in
respective medical discipline and checking cross infection

Nursing care should fall under the following categories:

• General Wards- Wards of traditional type for patients who are not critically
ill but need continuous care or observation and have to be in bed. These
include wards for medical, surgical, ENT and eye disciplines, etc.

• Private Wards (Optional)- Wards for patients who are in a position to pay
high towards Medicare. These may be air conditioned or non-air
conditioned.

• Wards for Specialities- Wards for patients who are suffering and need
hospitalization in particular specialties, like, pediatric, obstetrics,
gynaecology, neurology, nephrology etc.

• Location

Wards should be relegated at the back to ensure quietness and freedom


from unwanted visitors.

General ward units are of repetitive nature and hence they may be
conveniently piled up vertically one above the other which will result in
efficiency, easy circulation and service economy. Wards for particular
specialties, however, should be located closer to their respective
department to act as self-contained centers. In such case, post-operative
ward may be placed horizontal to operation theatre and maternity ward to
the delivery rooms.

• Planning ward unit

In planning a ward, the aim should be to minimize the work of the nursing
staff and provide basic amenities to the patients within the unit.

The distances to be travelled by a nurse from bed areas to treatment room,


pantry, etc, should be kept to the minimum for the ward unit may be made
of desired number of beds at the rate of 7 Sqmt. per bed and should
bearranged with a minimum distance of 2.25 mt between centre of two
beds and a clearance of 200 mm between the bed and wall.

In wards, the width of doors shall not be less than 1.2 mt and all wards
should have dado to a height of 1.2 mt. Isolation unit in the form of one
single bedded room per ward unit should be provided to cater for certain
cases requiring isolation from other patients.

An area of 14 Sqmt. for such rooms to contain a bed, bedside locker and
easy chair for patient, a chair for the visitor and a built in cupboard for
storing clothes is recommended. This isolation unit should have separate
toilet facilities.

• Size of the Patient Rooms

The patients’ beds must be accessible from three sides and this sets the
limits for the overall room sizes. The smallest size for a one bed room is
10m2; for a two and three-bed room, a minimum of 8m2 per bed should be
allowed (in accordance with hospital building regulations). The room must
be wide enough for a second bed to be wheeled out of the room without
disturbing the first bed (minimum width 3.20 m). Next to each bed must be
a night table and, where appropriate, towards the window there should be a
table (900 x 900 mm) with chairs (one chair per patient) The fitted
cupboards (usually against the corridor wall) must be capable of being
opened without moving the beds or night tables. In new buildings, the wet
cells should be located towards the inside, off the station corridor, because
future renovations will most likely make use of the external walls as the
means of extending the existing areas.

Patient Conveniences (Sanitary requirements)

Toilet for an individual room (single or twobedded) in a ward unit shall be


3.5 Sq.mt.comprising a bath, a wash basin and WC. Toilet common to
serve two such rooms shall be 5.25Sq.mt. to comprise a bath, a WC in
separate cubical and a wash basin. For multiple beds of a ward unit,
requirement offitments is given below:

ITEM NUMBERS REQUIRED


WATER CLOSETS 1 For Every 8 Beds Or Part Thereof
(Male)
1 For Every 6 Beds Or Part
Thereof(Female)
ABULATION TAB 1 In Each Water Closet Plus 1 Water
Tap With Draining Arrangement In
The
Vicinity Of Water Closets
URINAL 1 For Every 12 Beds Or Part Thereof
(For Male Only)
WASH BASIN 1 For Every 12 Beds Part Thereof
BATH 1bath With Shower For Every 12
Beds Part Thereof
BED PAN WASHING SINK 1 For Each Ward Dirty Utility Sluice
Room
CLEANER’S SINK AND 1 For Each Ward Dirty Slab Cleaning
SINKS/ Utility And Sluice Room
SLAB FOR CLEANING
MACKINTOS

KITCHEN SINK 1 For Each Ward In Wards


Dishwasher Pantry

STANDARDS FOR HOSPITAL:


Guideline areas for a standard hospital

Areas for the overall hospital including functional area for:

Supply/disposal 40-80 m2 PA/planned bed care area


Nursing area 19-25 m2 PA/planned bed
Intensive therapy 30-40 m2 PA/bed
Surgical area 130-150m2 PA/surgical unit
rehabilitation 19-22m2 PA/treatment place
physiotherapy 68-75m2 PA/treatment place
X-ray 60-70 m2 PA/diagnosis room
radiotherapy 300-350 m2 PA/equipment
Recovery area 25-30 m2 PA/recovery bed
NMR diagnosis 100-150 m2 PA/ diagnosis room
Clinical physiology 80-100 m2 PA/diagnosis room
Clinical neurophysiology 78-100 m2 PA/diagnosis room
Central reception 140-160 m2
PA/examination/treatment room
Delivery area 85-100 m2 PA/delivery room
dialysis 70-80 m2 PA/dialysis room
Specialist department 80-100 m2
PA/examination/treatment room
(PA= productive area)

CORRIDOR DOOR STAIR, LIFT AND RAMP

Corridors must be designed for the maximum expected circulation flow.


Generally, access corridors must be at least 1.50m wide. Corridors in which
patients will be transported on trolleys should have a minimum effective
width of 2.25m. The suspended ceiling in corridors may be installed up to
2.40m. Windows for lighting and ventilation should not be further than 25m
apart. The effective width of the corridors must not be constricted by
projections, columns or other building elements. Smoke doors must be
installed in ward corridors in accordance with local regulations.

DOOR
• When designing doors the hygiene requirements should be considered.
The surface coating must withstand the long- term action of cleaning
agents and disinfectants, and they must be designed to prevent the
transmission of sound, odours and draughts. Doors must meet the same
standard of noise insulation as the walls surrounding them. A double-
skinned door leaf construction must meet a recommended minimum sound
reduction requirement of 25dB. The clear height of doors depends on their
type and function:

• Normal doors 2.1O—2.20m

• Vehicle entrances, oversized doors 2.50m

• Transport entrances 2.70—2.80m minimum height on approach roads


3.50m

STAIR AND RAMP

Stairs should not have any abrupt nosing ensure adequate lighting without
confusing shadow minimum width 1.2 W. Maximum of 13 risers to a run. 17
cm tread and 25 cm tread Ramps should have a gradient 1:20 or less.

Stairs

• Railing height = 900 mm

• Minimum width = 1500 mm

• Maximum riser = 150 mm

• Minimum tread = 300 mm

• There should be not more than 12 steps in a single flight.

Ramps

• Maximum slope = 1:10 to 1:12

• Minimum width = 2500 mm


• Turning radius = 3000 mm

• Landing space = 3000 mm (for turning of stretchers)

• Railing height = 900 mm

• The floor should be non slippery.

Lifts transport people, medicines, laundry, meals and hospital beds


between floors, and for hygiene and aesthetic reasons separate lifts must
be provided for some of these. In buildings in which care, examination or
treatment areas are accommodated on upper floors, at least two lifts
suitable for transporting beds must be provided. The elevator cars of these
lifts must be of a size that allows adequate room for a bed and two
accompanying people; the internal surfaces must be smooth, washable and
easy to disinfect; the floor must be non-slip. Lift shafts must be fire-
resistant. one multipurpose lift should be provided per 100 beds, with a
minimum of two for smaller hospitals. In addition there should be a
minimum of two smaller lifts for portable equipment, staff and visitors:

• Clear dimensions of lift car: 0.90 x 1.20m

• Clear dimensions of shaft: 1.25 x 1.SOm

FOUR TYPES OF LIFT USE IN HOSPITAL

· Freight

· Dumb waiter

· Passenger-

· Hospital services-1 for upto50,2 for60-200


A suitable size 2 ton, with inside dimensions 1.6 M x 2.6 M x 2.1 M.

• Lifts are provided with facilities for either manual or automatic operation.

• Service lifts are the most flexible device for moving wheeled carriers.

• Bed lifts are essential for the_movement of beds.

• Door should close with maximum speed = 0.5 m/s.

• Lobby area = 5 – 6 m² per elevator on upper floors and 15 – 20 m² per


elevator at ground floor.

FIRE FIGHTING

Fire fighting installations are done as recommended sprinkler protection,


stand pipes, pumps and storage pressure tanks.

Sprinklers:

Used in basements, any room exceeding 500 m².

CO2: Used in electric fire, where water cannot be used, foam is formed
with soda ash.

Smoke detectors: Used where temperature rises between 0 - 38°c. (O.T,


I.C.U, lobbies, diagnostic deptt. etc). Air conditioning and ventilation
systems circulating air to more than one floor or fire area shall be provided
with dampers designed to close automatically in case of fire.

For fire escape staircase:


Minimum width = 1500 mm

Minimum tread = 300 mm

Height of hand rail = 1000 mm

Minimum width of exit door = 1500 mm

Minimum height of exit door = 2000 mm

Minimum width of corridor = 2400 mm

PLUMBING AND WATER SUPPLY

1-Plumbing

The plumbing should be capable of providing the water at the required


temperature at various points i.e. 110 F or 43° C for washing and 180° F or
83° C for sterilizing. The system should be capable of delivering 300
lt./bed/day.

Fixture

1. Lavatories - Goose neck faucets for all hand washing lavatories. The
valves should be controlled by foot, knee or wrist to prevent contamination.

2. Toilet fixtures - bed pan washer and a WC

3. Bathing facilities - elevated bath tub or shower fitted with spray head.

2-Water supply

Cold:

For domestic and drinking,

for flushing W.C. and firefighting.

Soft:

Air conditioning, laundry (in some cases, demineralized water is used).

Demineralized water: For boilers, dialysis.


Raw water: For gardening.

Hot water: For bathing, labs, kitchen, laundry, CSSD. Hot water is supplied
through the boiler (oil fired hot water generator).

Steam:For CSSD, laundry and kitchen. Steam is generated in boiler and


supplied through the horizontal and vertical distribution network. Pipe lines
are made of G.I., mild steel, copper and P.V.C. valves are provided to clear
off the gap or air from the pipes.

Hospitals including laundry liters/head/day

• No. of beds not exceeding 100- 240 (per bed)

• No. of beds exceeding 100- 450 (per bed)

DISPOSAL SYSTEMS

Five basic components:

• Handling waste at the point of production.


• Transportation within the facilities.

• Internal storage.

• Internal processing/ treatment.

• Transportation to point of final disposal. Solid waste should be sterilized at


for near the point of production source, preferably in disposable plastic
bags in containers. Pathologic waste should be sterilized at or near the
point of production, prior to removal from the place.

Two systems of incinerations are:

i). Oil/ gas fuel incinerator

ii). Electric incinerator

Oil/ gas fuel incinerator

Advantages

1. Reduces the volume of solid waste by 85– 90%

2. Pathological and infectious waste can be conveniently disposed off


within the premises

without much preparation and effort.

3. Heat recovery – can be used as stand by boilers that generate sufficient


steam to operate laundry and kitchen.

Disadvantages

• Maintenance cost is high

• Fuel consumption is high

Electrical incinerator

Advantages:

1. Low operating cost, 1/3 of those of oil/gas ones


2. No oil or gas pollution

Disadvantages:

1. Need standby power in event of a commercial power failure

2. Minimum area required for incinerator =60 sq. m.

HOSPITAL WASTE DISPOSAL

• Segregation of hospital waste from non-infectious(domestic type) waste,

• Packing of waste to isolate from the people and the environment ans to
prevent accidental spillage,

• Labeling of waste to avoid accidental tampering or contact with waste


materials, through ignorance of its presence and/or health hazards,

• Controlled management within hospitals and during transit to disposal,


such that collection, storage and transport is secure, well supervised and
maintained effectively at all times,

• Controlled disposal in a manner which minimizes access to unauthorized


people as well as animals (insects, birds, cats, etc.)

• Hospital wastes needs to be collected and treated within a maximum


period of 48 hours from the time of generation.
A.C. PLANT

Complete air conditioning provides following conditions for both summer


and winter:

1. Air movement and circulation

2. Air filtration, cleaning and purification

3. Temperature control

Design considerations:

· Restricted movement of air in between various departments to avoid


cross contamination.

· Ramps and stairs are not considered for air conditioning.

· Soft water plant shall be provided for supplying soft and filtered water.

· Ducts are made up of G.I., Aluminum. And concealed to avoid noise


INFERENCES:

• Adequate waiting areas in all departments.

• Atrium houses a large number of visitors and has different accesses to


different departments thereby restricted the flow ofvisitors to this areas
only.

• The Service Block forms the major hub for hospital functions, without the
interference of the main stream of the hospital.

• Segregation of visitor, staff and service entry.

• Separate emergency entry, which has a direct and unhindered access.

• Separate service lift for food, linen, staff,visitors and patient help to avoid
congestion.

• Flexibility for the future so that any floor could be converted from wards to
rooms and vise-versa.

• Toilets are designed according to the needs of patient.

• Emergency evacuation is not catered for since there is no provision of a


ramp.

• Lack of separate fire escapes in fire blocks.

• Lack of natural light and ventilation in lower floors.

• No dirt disposal corridor in the O.T. complex.

• Increase in the cost because of introduction of service floors in the


building.

• Service floors create better floors usability as area in services is


segregated on floors.

• Service floors gives design flexibility as services considerations in design


arereduced.
OUT PATIENT DEPARTMENT:

1. Adequate waiting spaces in o.p.d.

2. Central waiting space betweeno.p.d. & diagnostic deptt..

EMERGENCY:

1. Peak activity can done at any time .

2. Entrance should be unobstructed for min. time consumption .

3. Emergency should be linked with diagnostic facility and o.p.d.

4. Minor o.t. in emergency.

IN PATIENT DEPARTMENT:

1. Ventilation &view from every ward .

2. Piped oxygen and suction should be provide in each ward.

3. Distance of nurse stn.from the should be min. for max. efficiency.

4. Separate isolation units should be provided for patients carrying infection


or liable to get infected.

5. High dependency ward direct related to nurse station.

6. Toilet should be designed according to the needs of patient.

OPERATION THEATRE & I.C.U :

1. Placement should be in a noise free hygienic environment.

2. Blood bank, cvt ,Icu , radiology and pathology should be close

to OPERATION THEATRES.

3. O.T. in between diagnosis & ward.

4. Separate entry for doctor, nurses& patient.

5. Access to the i.c.u. & o.t. must be strictly controlled.


DIAGNOSIS:

1. Diagnosis should be accessible to both o.p.d. and i.p.d.

2. Diagnosis should be near to emergency.

3. Adequate waiting space .

SERVICES:

1. C.S.S.D. is generally placed blow the o.t. complex connected through


dumb waiter.

2. Care should be taken to see that there is no conflict in the circulation of


soiled material and the sterilized material.

3. Staff dining rooms are generally sited near the kitchen.

4. Incinerator creates a lot of heat, sound and fumes, it will be economical


to keep it separate from other areas or else

a high chimney should be provided.


Case study

ÖSTRA HOSPITAL

PSYCHIATRIC FACILITY This has provided scientific evidence suggesting

that well designed medical architecture can help

reduce aggression and violent situations within

psychiatric in-patient care.”

– Roger Ulrich

Location :Göteborg, Sweden

Project Address Östra Sjukhuset, Journalvägen 5, 416 50 Göteborg,


Sweden

Project Type :Medical Facility

Square Feet: 193,750 (18,000 m2)

Year of Completion: 2006

Occupant: Patients, Staff, Guests

DesignTeam :White Architects

Awards: Forum’s Healthcare Building Award

2007 Second place – WAN Healthcare Building


of the Year Award

Biophilic Patterns : Complexity & Order Visual


Connection to Nature Dynamic and Diffuse Light
Refuge
Mental illness is often stigmatized, and patients can feel embarrassed or
ashamed of their need to seek care. Worse yet, mental health facilities are
stereotyped as bleak, institutional buildings that one wouldn’t choose to
spend time in. At Östra, the designers wanted to wipe out these
preconceived notions from the entire experience. To do so, they carefully
considered the patient experience from the moment someone approaches
the building’s entrance, to the treatment rooms, amenities, and guest
experience of visitors.

The facility was designed to be a healing environment, and to support


connections with nature, all while adhering to the unique safety and
security needs of a psychiatric facility.

Staff must be able to monitor patients, and to ensure their safety in the
facility. Despite these challenges, White Architects incorporated access to
outdoor spaces while still adhering to the safety requirements.

This case study explores the strategies used to establish a biophilic


experience, including the layout of each department, access to nature both
indoors and outdoors, and the variety of individual and community spaces.

The design considers the varying needs of both patients and healthcare
professionals, creating an environment that cares for all its occupants.

PROJECT SUMMARY

To design the new psychiatric facility at Östra Hospital in Sweden,

White Architects began by asking, “Can good architecture alleviate the


suffering of psychiatry patients and their families?

Can it speed recovery and thus be said to enhance the efficacy of care?”
With these questions in mind, White Architects created a welcoming and
caring environment that treats the facility’s design as an element of patient
care. The new facility is also integrated into the campus that delivers
somatic care, helping to reduce the stigma and isolation of mental
illnesses. Nature is a significant influence throughout the facility as access
to nature has been shown to have positive effects on health and wellbeing.
NATURE IN THE SPACE

[P1] Visual Connection with Nature: Patient rooms have views to the
central gardens; light courts are planted with low vegetation

[P2] Non-Visual Connection With Nature: Operable windows bring the


sounds and smells from the garden in, courtyards feature edible plants

[P3] Non-Rhythmic Sensory Stimuli: In the garden courtyards, occupants


can feel breezes, see cloud movements, and hear bird and insect sounds

[P4] Access to Thermal & Airflow Variability: Patient rooms and sun rooms
have operable sun shades and windows

[P5] Presence of Water: Not significantly represented in design

[P6] Dynamic & Diffuse Light: Light courts in the heart of each department
bring natural light into the space
[P7] Connection with Natural Systems: Garden courtyards show effects of
weather and seasonal changes in nature

NATURAL ANALOGUES

[P8] Biomorphic Forms & Patterns: Not significantly represented in design

[P9] Material Connection with Nature: Polished stone floors, oak hardwood
floors, birch handrails, and unpainted wood furniture

[P10] Complexity & Order: Repeated L-shaped pattern of the spatial


configuration

NATURE OF THE SPACE

[P11] Prospect: Long distance views are available from the garden and
through many of the windows

[P12] Refuge: Arbor-like seating off the path in the garden courtyards;
nested private to public spaces within the departments
[P13] Mystery: Not significantly represented in design

[P14] Risk/Peril: Not significantly represented in design

Floor Plan: The building layout is comprised of four modules with garden
courtyards between each. The modules are connected by the building’s
spine.

Repeated spatial arrangements simplify navigation for staff, patients, and


visitors.

[P10] COMPLEXITY & ORDER

The floor plan is composed of four repeating L-shaped departments, three


outdoor courtyards, and a connecting “spine.” Each department is self-
sufficient and contains treatment rooms, administrative offices and living
areas. These spaces together make up each of the L-shaped departments.
Three of the departments are positioned side by side, with a fourth rotated
to create the 3 large central garden courtyards. The repeating spatial
arrangements make Östra easier to navigate for staff. Once staff are
familiar with one department, they can navigate them all.

Östra’s subdivision of space at the departmental scale is an example of

complexity and order: sensory information that adheres to a spatial


hierarchy similar to those encountered in nature.

Within each department, it was important to designers to create a layout


that allows patients to navigate and feel a sense of ownership over their
environment, as the average patient stay is over 19 days. Either individual
or double units, all of the rooms have access to natural daylight and are
part of a spatial grouping of rooms within the larger department. Each
cluster of patient rooms also has access to a semi-private circulation and
sun room. From this outer hallway, the department transitions inwards to
the semipublic communal space created by the light courtyard. This
transition from private/ personal (individual) to semi-private (family), and
semi-public (tribe) breaks the department into various environments and
allows patients to participate in all three realms depending on their
preference. Patients can choose where and how to interact with others,
adding to the sense of normalcy and independence.

The layout also helps staff maintain security in the departments. Each
section can be monitored and secured easily, and staff can immediately
find their way in any department.

[P1] VISUAL CONNECTION W/ NATURE

The Östra design works to ensure all patients have consistent access to a
view of elements of nature, living systems, and natural processes. The
placement of the three central courtyards between the departments
ensures that even rooms in the center of the building have access to nature
views. This, along with the interior light courts, brings nature into the space.

This project is unique in that visual connection with nature is used not only
to enhance the occupant experience within the building, but also to
encourage patients to go outside, either by using the indoor light courts or
larger central garden courtyards. Patients are able to access the garden
courtyards on their own, which provides a sense of independence and
control in addition to the benefits of being in nature

Like any mental health facility, security and safety while in the building are
major constraints on the building’s form. When speaking about the
importance of including nature in creating a nurturing experience,
landscape architect Carina Tenngart Ivarsson said, “The positive effects on
physical, mental and social wellbeing greatly outweigh the problematic
security and secrecy aspects, which however are not to be gainsaid.” The
wellbeing benefits of free access to nature for the patients are balanced
against the added security concerns for the staff. Designers felt that if the
facility were built to be inescapable, it would encourage escape attempts. If
it were built to be beautiful and welcoming, it would more likely be
respected and contribute to occupant wellbeing.

[P6] DYNAMIC & DIFFUSE LIGHT

Access to dynamic and diffuse light — varying intensities of light and


shadow that change over time to create conditions that occur in nature — is
seen throughout the facility. Several studies have successfully
demonstrated the beneficial effect of natural light on depression, sleep
disturbances, circadian rhythm and physical aggressiveness, making it an
important design aspect of the facility.

Each grouping of patient rooms has a corner sun room with windows on
two walls, while individual (private) rooms have windows. Operable blinds
allow patients to adjust the level of light according to their preference.
Additionally, light courts at the heart of each department bring daylight to
the interior spaces where no windows are available. These light courts are
the center of the communal area, bringing light not only into the court itself,
but also the other surrounding community spaces like the dining area.

“Use of daylight is primary, resulting in narrow volumes and well-lit rooms.


The care devoted to lighting is unmistakable: the lighting strengths are low
in relation to present-day medical care; the light is sparing, something
verging on darkness” (Architecture as Medicine). The use of light at Östra

Hospital is reminiscent of a domestic setting, helping patients to feel at


home in the space.

[P12] REFUGE

Studies have shown that prospect and refuge spaces reduce stress and
allow patients to feel in control of their surroundings. “If patients are allowed
to personalize and otherwise show their territories, the researchers tell us,
then the social atmosphere should improve and the environment be
perceived in a more positive light” (White Architecture).

Examples of refuge are abundant in the design. The hierarchy of spaces


nest private spaces away from more public communal areas, allowing
occupants to choose their preferred level of interaction in the department’s
activities. From individual rooms to shared sunrooms and gathering
spaces, to a central space with the light court, occupants have numerous
ways to experience their environment. Additionally, the shared sunrooms
have operable sunshades to shield views from the outside and increase the
sense of refuge. The central space with the light court also uses furniture,
like high-backed chairs, to create partial refuge conditions.

The garden courtyards also provide Refuge conditions. The paths are all
walkable and feature arbor-like seating areas that create a sense of
prospect and refuge. Individuals have the comfort of the arbor—which is
withdrawn from the main flow of activity and protects the individual from
behind and overhead—while still being able to view their surroundings. The
use of a delicate arbor also ensures that individuals don’t feel trapped or
enclosed.
HEALTH BENEFITS

White Architects implementation of the biophilic patterns has the potential


to provide the following benefits to occupant health and wellbeing:

[P1] Visual Connection with Nature: Lowered blood pressure and heart
rate; improved mental engagement/attentiveness; positively impacted
attitude and overall happiness.

[P6] Dynamic and Diffuse Light: Positively impacted circadian system


functioning; increased visual comfort.

[P10] Complexity & Order: Positively impacted perceptual and physiological


stress responses; observed view preference.

[P12] Refuge: Improved concentration attention and perception of safety

These patterns can decrease feelings of stress, and contribute to the


healing environment that the designers aimed to create within the new
facility. By using multiple patterns to achieve the same health response,
designers address the variability in user preference and increase the
likelihood that the biophilic design of the space will have a positive effect on
patient health.

A HEALING ENVIRONMENT

Data collected from 2005, the year before themove to Östra, compared to
2007, the year after the move, show that there are noticeable
improvements in the number of compulsory injections and restraints per
quarter, as well as a decrease in sicklisting of staff. (Table 1,

2, 3).

“The need for coercive medication has diminished. The need for shackle
restraint has diminished. Re-admissions within seven days of discharge
have diminished. Sicklisting of staff has diminished. The survey material is
small but of great importance. This is the first quantifiable study ever
undertaken in Sweden concerning the importance of the physical
environment for the healing process in psychiatry” (Architecture as
Medicine).

While the data show a positive difference between Östra and the previous
facility one occupants, both patients and staff, the exact mechanism found
to be most beneficial to these outcomes is difficult to determine.

Evidence based design (EBD) attempts to create positive outcomes on


human health and wellbeing through sound science rooted in existing peer-
reviewed research. Data collected at Östra Hospital psychiatric facility,
analyzed in the context of outside research findings, will contribute to the
growing knowledge base in the field of EBD.

Informal interviews with patients and staff further indicate that the building’s
design has played a role in the patient experience.

“Spontaneous remarks by patients, staff and visitors show the huge


importance attached to the thought of someone really having taken the task
absolutely seriously and exerted themselves to create a beautiful building
showing respect for everyone who will be using it” (Architecture as
Medicine)

Activity Within Nature

Home garden plots were incorporated into one of the courtyards for
patients and staff to plant in. This place-making strategy provides
occupants with the opportunity to take ownership of their environment. The
plots were so successful, patients asked to incorporate them into all three
courtyards.

Patients can be seen sitting on the benches, tucked away between


greenery, taking advantage of the therapeutic refuge and visual connection
with nature conditions provided.

The care that went into creating space for patients to use freely, and the
care that went into the entire design, is a reminder that Östra is a place of
healing. The psychiatric facility at Östra Hospital is structured to promote
health and wellbeing through connections to nature.
Closed psychiatric departments have locked doors. But it does not mean
that the indoor environments need to have a heavy, institutional feel. The
opposite is actually a precondition for achieving a healing environment.

An overall desire at Östra Hospital was to break the stigmatisation


associated with psychiatric care. The fact that the aesthetics and function
of the premises are very important for recovery is absolutely clear.

We worked from the goal of creating a free and open atmosphere, of


avoiding all associations with compulsion and power. The design includes a
welcoming entrance with an entrance hall three storeys high. Large glazed
section and illuminated, red-stained birch panels set their stamp on a room
that meets everyone – relatives, staff and patients on parole.

The psychiatric activities are grouped around a central passageway that


connects to the top storey of the entrance hall. All public areas are situated
along this passageway. Here are also the entrances to the actual treatment
areas, as well as to administration and management.

The care departments are based on three cornerstones: The garden, “the
heart”- where you gather the patients for activities, and the accommodation
group. In the ‘protected outdoor area’ no staff cards are required, and some
patients even have their own exit to the garden. The design is intended
gradually to increase the patients’ personal spheres, from their own room,
to the garden, café and public areas.