Design a cardiac hospital that breathes

Architect Hussain Varawalla writes on the intricacies involved in designing a cardiac hospital

The operation theatre suite is truly the “heart” of a cardiac hospital, for this is where the bypass surgeries are performed (doctors call them CABGs, or Coronary Arterial Bypass Grafts), and these theatres are designed adjacent to cardiac catheterisation laboratories.

In a rare instance, an angioplasty procedure will puncture the wall of the artery, and emergency surgery will be required, hence the contiguity. The theatres should be provided with High Energy Particulate Arresters (HEPA) filters and dedicated air-conditioning conforming to applicable standards of sterility.

The cath labs do not require the same degree of sterility as the surgical suite, as the procedures are minimally invasive (there is no gaping wound). The cath labs should be contiguous to a day care ward, as “graphies” are a day care procedure. Many a times, however, the apprehensions of patients and relatives make them opt for an overnight stay in the hospital. The theatres are usually also contiguous to the surgical Intensive Cardiac Care Unit (ICCU), on the same floor, if the particular design circumstances allow it.

Each pair of cubicles in the ICCU should have an observation station with a sink, to enable continuous, comfortable attention to each patient by nursing staff, and also be conducive to preventing cross-infection by enabling nursing staff to wash their hands after each patient interaction.

Structural design for the building should be done to facilitate future changes in layout and to provide for new demands that these changes may make on building services like electricity, air-conditioning or plumbing. The podium slabs should be designed to support new walls at any point. A grid slab allows for punctures anywhere. Service shafts, column design, elevator provisions and water supply and sewage pipe sizing should allow for substantial, planned expansion.

Successful hospitals grow, and more often than not this growth can be a painful and traumatic process for the hospital. It needs to be planned for in advance, ideally at the time of planning the initial facility itself. Changing market demands, new technology replacing the old at an ever-increasing rate of change, advances in the science of medicine and changing patterns of disease all underline the need to design health care buildings for flexibility.

The functional, technical and hence financial success of hospitals thus depends on the ease with which they can grow and change, and this dependence increases with time. The fact that many hospitals are built in a number of phases further complicates the problem. There may be limits to the amount of investment possible at any one time. A comprehensive and firmly established Development Control Plan is essential for a hospital built in phases - to specify the strategic direction of following phases.

The issue is complex; it involves a multiplicity of design factors that may be making contradictory demands on the designer. If you are building a hospital, we suggest you consider the various options keeping in mind the needs of future generations to whom you will bequeath your design solution in its built form. The interior spaces of the hospital should be drenched in natural light and the facility should be wrapped in abundant greenery, thus enabling the building structure and its interior spaces to become an active partner in the process of healing. Light also affects the human body. Patients can become psychotic through sensory deprivation or sensory overload.

It is tremendously important to experience the natural cycle of light and dark and to be wheeled out into the sun. A terrace garden should be provided for this very purpose, and most importantly, the intensive care units should have ample natural light designed into them. Instead of allowing technology to make medical care seem more sterile and impersonal, the hospital should use technology in an invisible way to speed the delivery of care and make patients even larger partners in their healing.

This enabling of patients to affect their treatment in a meaningful way by being informed of all that will happen during their stay and made to discuss this proposed series of activities with the care-givers is an important operational policy in hospitals tuned into the new paradigm.

The interior design of the hospital should be done with the intention of reducing stress by creating a more relaxed environment and supporting the patient’s dignity and identity. It is necessary to have a patient-focused, collaborative design effort between the architects and the interior designers, to create an environment conducive to healing.

This approach to holistic design makes good sense in terms of patient, staff and visitor satisfaction and it’s effect on patient recovery, which is of considerable interest to health care providers.

Hospitals, cardiac or otherwise, as vehicles for improving the health of the community they serve, should take the lead in embracing “green” or “sustainable” architectural design processes, they should be designed to minimise their energy demands and use eco-friendly design and construction processes. What does the future hold for cardiac surgery? In an era of new technologies and increased health awareness among people in general, the following factors will have an impact on this:

1. New, drug-coated stents will make angioplasty an increasingly popular and effective alternative to surgery.
2. Improved imaging techniques within the Operating Theatre will allow minimally invasive cardiac surgery.
3. “Beating heart” surgery has already reduced the need for heart-lung machine usage.
4. Improved drug regimens will dissolve clots without the need for any invasive procedure.
5. Early diagnosis by scanning high-risk patients will lead to increased heart healthiness through timely changes in lifestyle. The emphasis is changing from cure to prevention.

What do these changes foretell for the architect and the design of cardiac facilities?

1. Increased emphasis on and usage of outpatient consultation, diagnosis and procedures and hence the greater need for such facilities.
2. Increased need for the cardiac facility to take the lead in preventive measures by community outreach programs, and hence the physical need within the facility for holding workshops, lectures and exercise programs. This leads to the aesthetic of the building suggesting a more welcoming and less threatening outward face.
3. Inpatient care becoming more acute, with the average inpatient being a “sicker” patient. This could lead to the conception of the inpatient room as a “mini-ICU”, in terms of facilities, space and layout.

What factors would contribute to the success of a cardiac care facility? The important factors:

1. Competent consultants from the onset of the project.
2. The vision of the client.

The author is director-Design Services with Hosmac (India) Private Limited, Mumbai