pam cpd 9th august 2008 1 presented by assoc. prof. datin ar. norwina mohd nawawi international...

PAM CPD 9th August 2008PAM CPD 9th August 2008 11

Presented byPresented byAssoc. Prof. Datin Ar. Norwina Mohd NawawiAssoc. Prof. Datin Ar. Norwina Mohd Nawawi

International Islamic University MalaysiaInternational Islamic University Malaysia

Hospital Design – a brief Hospital Design – a brief insight on the development insight on the development of hospitals in Malaysia in of hospitals in Malaysia in

comparison to projects comparison to projects overseasoverseas


OutlineOutline

IntroductionIntroduction• HealthcareHealthcare• Hospital ArchitectureHospital Architecture

Development of Hospital AbroadDevelopment of Hospital Abroad Malaysian Healthcare ServicesMalaysian Healthcare Services Development of Malaysian Hospitals pre Development of Malaysian Hospitals pre

and post independenceand post independence Current issues in hospital developmentCurrent issues in hospital development Summary Summary


IntroductionIntroduction

Healthcare and Hospital Healthcare and Hospital ArchitectureArchitecture


IntroductionIntroduction ““Health care presents a different problem in Health care presents a different problem in

every country for the way it is organised is a every country for the way it is organised is a response to response to geography, climategeography, climate, historical , historical development, economic situation and social, development, economic situation and social, cultural and political conditions…cultural and political conditions…

Appreciation of these differences is Appreciation of these differences is fundamental to understanding of the fundamental to understanding of the situation which prevails in a country.”situation which prevails in a country.”

Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co.


Definition on HealthDefinition on Health

““Health is a state of complete physical, mental, Health is a state of complete physical, mental, and social well-being and not merely the absence and social well-being and not merely the absence of disease or infirmity”of disease or infirmity”

W.H.O.W.H.O.

““Health, as we define it today, is a state of Health, as we define it today, is a state of

complete physical, psychological, social and complete physical, psychological, social and spiritual well being.”spiritual well being.”

Islamic worldviewIslamic worldview

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


What is healthcare?What is healthcare? ““Essential health care based on practical, Essential health care based on practical,

scientifically sound and socially scientifically sound and socially acceptable methods and technologies acceptable methods and technologies made universally accessible to individuals made universally accessible to individuals and families in the community through and families in the community through their full participation and at a cost that their full participation and at a cost that the community and country can afford to the community and country can afford to maintain at every stage of their maintain at every stage of their development in the spirit of self-reliance development in the spirit of self-reliance and self determination”and self determination”

The Declaration of Alma Ata in 1978The Declaration of Alma Ata in 1978


Health PyramidHealth Pyramid Healthcare buildings encompass the Healthcare buildings encompass the

predefined healthcare strata of PRIMARY, predefined healthcare strata of PRIMARY, SECONDARY and TERTIARY level of care. SECONDARY and TERTIARY level of care.

Tertiary

Secondary

Primary


The Level of CareThe Level of Care Primary carePrimary care embraces all the general health embraces all the general health

practices, educational, preventive and curative, practices, educational, preventive and curative, that are offered to the population at the point of that are offered to the population at the point of entry into the System.entry into the System.

Secondary CareSecondary Care comprises the care provided by comprises the care provided by more specialised services to which people are more specialised services to which people are rendered by the primary care services.rendered by the primary care services.

Tertiary CareTertiary Care includes highly specialised includes highly specialised services not normally found at secondary level, services not normally found at secondary level, including super-specialities such plastic surgery, including super-specialities such plastic surgery, neurosurgery and heart surgery. neurosurgery and heart surgery.

Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co.


Principle of Referral of PatientsPrinciple of Referral of Patients

The principle of The principle of referral of patientsreferral of patients from from a lower level of care to a higher level as a a lower level of care to a higher level as a method of method of sortingsorting them according to their them according to their need for specialist diagnosis or the need for specialist diagnosis or the nature or the degree or their disabilities is nature or the degree or their disabilities is also universally recognised.also universally recognised.

Another is aim to work in both direction Another is aim to work in both direction for which the reverse is meant for for which the reverse is meant for convalescence.convalescence.


Basic Hospital Forms and ConfigurationsBasic Hospital Forms and Configurations

Diagnostic & Treatment zones

Diagnostic & Treatment zones

The Outpatient ZoneThe Outpatient Zone

Medical and Non Medical Support Zones

Medical and Non Medical Support Zones

Supplies and Disposal

Visitors

Em

erg

enc

y E

ntry

Visitors Control

Visitors Control

Inpatient zonesInpatient zones

Naturally ventilated areas are normally long and thin while fully air conditioned areas are thick and wide

Outpatient entry

visitors

In the tropics


Ward LayoutWard Layout

Clinic LayoutPatient Waiting Area

C/E rooms

C/E rooms

Dirty Utility

Treatment RoomStores

C/E rooms

C/E rooms

Procedure Room

C/E rooms

Clean Utility

Staff corridor Linking to staff areas

Linking to Main Entrance or Hospital Street

Natural Day light

reception

natural ventilation and natural lighting.


Development of Hospital Development of Hospital Architecture AbroadArchitecture Abroad

UK, USA, EUROPE,JAPAN, UK, USA, EUROPE,JAPAN, SOUTH AFRICA, BRAZIL…SOUTH AFRICA, BRAZIL…


British ExperienceBritish Experience In the early 50s-60s during the In the early 50s-60s during the energy crises,energy crises,

the British the British embarked on several hospital embarked on several hospital development program starting from development program starting from • the Greenwich experience, the Greenwich experience, • through the Harness system, through the Harness system, • the Best Buy Mark I, then Best Buy Mark II,the Best Buy Mark I, then Best Buy Mark II,• through the varied Nucleus Hospital program through the varied Nucleus Hospital program

including the energy efficient Nucleus Hospital of St. including the energy efficient Nucleus Hospital of St. Mary on the Isle of Wright.Mary on the Isle of Wright.

• Now ..one off designs through……Private Now ..one off designs through……Private Finance Initiative (PFI)Finance Initiative (PFI)


Greenwich hospitalGreenwich hospital

The construction methods would be revolutionary - all lateral engineering services were to be contained in a 6-

foot gap between floor and ceiling of each pair of floors so that repairs and maintenance works could be carried out without disturbing ward or department routine. All wards would have natural light but the service departments e.g. x-ray, pathology and operating theatres would be in the

centre and artificially lit.The whole hospital was to be ventilated mechanically and

none of the windows would open so that the air in the wards would be as ‘pure’ as possible.

PLANPLAN

floor

InterstitialService floor

http://mysite.wanadoo-members.co.uk/offkilter/page6.html retrieved 070808

closed on 31st March 2001.


USA ExperienceUSA Experience

Being on private insurance based healthcare Being on private insurance based healthcare system, asystem, architects in the United States had to rchitects in the United States had to convince the convince the facility facility management that management that good good healing design healing design is profitable.is profitable.

Extensive Extensive campaign campaign or or crusades on both sides of crusades on both sides of the Atlantic to market the will of the Atlantic to market the will of healing healing environment through provision of good view, environment through provision of good view, music therapy, good interior design, lots of music therapy, good interior design, lots of sunlight, fresh air and energysunlight, fresh air and energy efficiency through efficiency through passive design strategiespassive design strategies are done with m are done with many any researches being conducted to provide evidence researches being conducted to provide evidence that environment do indeed improves the person that environment do indeed improves the person health outcomes.health outcomes.


European ExperienceEuropean Experience In Europe, In Europe, apart from access to daylight and fresh apart from access to daylight and fresh

air, strategies for passive designair, strategies for passive design include the choice include the choice of building materials for healthcare buildings that of building materials for healthcare buildings that has rigorous requirements. has rigorous requirements. • The material is specifically specified to be environment The material is specifically specified to be environment

friendlyfriendly e.g. e.g.the choice of wall and floor finishes the choice of wall and floor finishes shouldshould not not be from material that canbe from material that can burn nor emit toxic fumes. burn nor emit toxic fumes.

BBuilding services system uilding services system should should promote the recycle promote the recycle of waste water; retention of natural water before of waste water; retention of natural water before gradual discharge; recycle heat energy of air gradual discharge; recycle heat energy of air condition to radiators; use of solar power with photo condition to radiators; use of solar power with photo voltaic, wind energy and others. voltaic, wind energy and others.


The Asian ExperienceThe Asian Experience There have been movement in the Asian scene There have been movement in the Asian scene

about going back to tradition and local Asian about going back to tradition and local Asian values when designing hospitals. values when designing hospitals.

The deep rooted wisdoms on the use of The deep rooted wisdoms on the use of Feng Feng ShuiShui (literally means (literally means wind, waterwind, water) by the Chinese ) by the Chinese and and Vaastu ShastraVaastu Shastra by the Indians had made by the Indians had made significance come back in this millennium. significance come back in this millennium.

Both values, are basically Both values, are basically based on the planning based on the planning of the environment that deals with orientation of the environment that deals with orientation and provision of good healthy living. and provision of good healthy living.


Worldwide experience summaryWorldwide experience summaryMore hospital planning layouts are going away from deep planning and More hospital planning layouts are going away from deep planning and

massive concept to thinner blocks with courtyardsmassive concept to thinner blocks with courtyards to provideto provide

opportunity for all habitable rooms or spaces to have a natural daylight and view to the outside;


• More patients’ spaces are accessible to the More patients’ spaces are accessible to the gardens or sizeable courtyards whether it is on gardens or sizeable courtyards whether it is on the roof-tops or on the ground floorsthe roof-tops or on the ground floors;;

Nortalie Hospital, Sweden

Albert Einstein Hospital, Sao Paolo


• More external cladding, although of high tech More external cladding, although of high tech material, provides the shades and light at material, provides the shades and light at their openings through provision of retractable their openings through provision of retractable blinds or hoods as and when necessary.blinds or hoods as and when necessary.

Sunderby Hospital, Sweden


Atriums with gardens and natural daylighting are Atriums with gardens and natural daylighting are a common feature. Due to their four seasons and a common feature. Due to their four seasons and differential natural day-lighting intensity differential natural day-lighting intensity throughout the year, ventilation systems need to throughout the year, ventilation systems need to be boosted with mechanical means to provide the be boosted with mechanical means to provide the space with the required thermal comfort level.space with the required thermal comfort level.


Malaysian Healthcare Malaysian Healthcare Services SystemServices System


Malaysia – Vital StatisticsMalaysia – Vital Statistics

Other Vital StatisticsLand Area: 330,252 sq kmPopulation ( 2006): 26,640,200 Population Density: 81 / sq. kmPopulation Growth: 1.5%14 States

Source: Health Facts 2006, Ministry of Health Malaysia

Bel

ow

15

year

s –

33%

15-6

4 ye

ars

–63%

65 y

ears

& a

bo

ve-4

%


Malaysian Health VisionMalaysian Health Vision

“ “ Malaysia is to be a nation of healthy Malaysia is to be a nation of healthy individual, families, and communities, through individual, families, and communities, through a health system that is equitable, affordable, a health system that is equitable, affordable, efficient, technological appropriate, efficient, technological appropriate, environmentally adaptable and consumer environmentally adaptable and consumer friendly, with emphasis on quality, innovation, friendly, with emphasis on quality, innovation, health promotion and respect for human health promotion and respect for human dignity, and which promotes individual dignity, and which promotes individual responsibility and community participation responsibility and community participation towards an enhanced quality of life”towards an enhanced quality of life”

Ministry of Health Malaysia


The health vision is not static but The health vision is not static but dynamic that sets in place framework dynamic that sets in place framework to ensure that the health system could to ensure that the health system could develop and adapt to the changing develop and adapt to the changing environmentenvironment

Health care facilities were Health care facilities were pragmatically plan and developed to pragmatically plan and developed to provide the support towards that visionprovide the support towards that vision


Spectrum of Healthcare FacilitiesSpectrum of Healthcare FacilitiesLevelLevel Primary CarePrimary Care Secondary CareSecondary Care Tertiary CareTertiary Care Long Term CareLong Term Care

TypeType

Promotive . Promotive . Preventive, Preventive, CurativeCurative

CurativeCurative Curative, Curative, RehabilitativeRehabilitative

Home/Palliative/Home/Palliative/Terminal CareTerminal Care

Built Built facilitiesfacilities

Midwife/Rural Midwife/Rural Health ClinicHealth Clinic

Cottage Hospital 20-Cottage Hospital 20-70 beds70 beds

National Referral Centre National Referral Centre of Excellenceof Excellence

hospiceshospices

Dispensary / Dispensary / mobile mobile DispensaryDispensary

Non Specialist Non Specialist Hospital 70-150 bedsHospital 70-150 beds

Teaching hospitals –Teaching hospitals –public and privatepublic and private

elderly/retirement homeselderly/retirement homes

Health post Health post Specialist Hospital Specialist Hospital 150-350 beds 150-350 beds

Research institutionsResearch institutions- Institution of Medical - Institution of Medical Research (IMR)Research (IMR)

Special Institutions – Special Institutions – RehabilitationRehabilitation

Flying DoctorsFlying Doctors Private HospitalsPrivate Hospitals Organ based hospitalsOrgan based hospitals

Cardio ThoracicCardio Thoracic

Eye Hospital (Private)Eye Hospital (Private)

cancer, leprosarium, cancer, leprosarium, psychiatrypsychiatry

Health Clinic Health Clinic /Community /Community ClinicClinic

Specialist Hospital Specialist Hospital 350-550 beds 350-550 beds

- Specialist Hospital - Specialist Hospital 550-750 beds (State 550-750 beds (State /Regional)/Regional)

nursing homesnursing homes

Private GPsPrivate GPs

Infectious Infectious DiseaseDisease

Infectious Disease Infectious Disease (CID)(CID)

Support FacilitiesSupport Facilities

cerebral palsy centrescerebral palsy centres

public health/ public health/ school /dentalschool /dental

Private Maternity Private Maternity HomesHomes


Government / Public Sector 75-80%Private Sector

20-25 %

Min. of EducationMin. of Education

Min. of Home Affairs

Min. of Home Affairs

Dept. of AboriginesDept. of Aborigines

Armed ForcesArmed Forces

Min. of HealthMin. of Health

FEDERAL GOVERNMENT

Public health/medicineDisease ControlLaw Enforcement

FEDERAL GOVERNMENT

Public health/medicineDisease ControlLaw Enforcement

STATE/ LOCAL GOVERNMENTEnvironmental Sanitation,Housing Standards,Implementation,Law enforcement

STATE/ LOCAL GOVERNMENTEnvironmental Sanitation,Housing Standards,Implementation,Law enforcement

PRIVATE HEALTH CARE FACILITIES

PRIVATE HEALTH CARE FACILITIES

Source: Ministry of Health Malaysia


IntroductionIntroduction

On the On the macro levelmacro level, the paper relate on , the paper relate on the the national referral systemnational referral system then, in place then, in place and in the process of planning; and in the process of planning;

On On micro aspectmicro aspect, the design development , the design development of these hospitals were discussed on the of these hospitals were discussed on the rationale of its development as outcome of rationale of its development as outcome of the country’s health trend.the country’s health trend.


Malaysian Healthcare Referral SystemMalaysian Healthcare Referral System

State/General Hospital

State/General Hospital

National Referral Hospital

National Referral Hospital

Large District Hospital

Large District Hospital

Medium District Hospital

Medium District Hospital

Small District Hospital

Small District Hospital

Health ClinicHealth Clinic

Community Health Clinic/ Rural Health Clinic

Community Health Clinic/ Rural Health Clinic

Just over 1000 beds

Not more than 1000 beds

500-750 beds

300-500 beds

150-300 beds26-150 beds

With and withoutAlternative Birthing Centre

SE

CO

ND

AR

Y

CA

RE

TE

RT

IAR

Y

CA

RE

PR

IMA

RY

CA

RE

No

rmal

re

ferr

al

Em

erg

en

cy r

efe

rra

l


Bed NumbersBed Numbers

0

10000

20000

30000

40000

50000

60000

1995 1997 2006

Total beds

Private

PublicAcutePublicSpecialNon MoHgovt

1995 1990 1995 2006

Acute Bed: 1000 population

1.37 1.30 1.18 1.16

Bed to Pop ratio 1:482 1:531 1:477 1.887


The Private SectorThe Private Sector


post independent period1957-1970sColonial

Period 1700-1957

Pre Colonial Period

Mid 1970s-1990s

Simple structuresTropicalArchitecture

Non StandardSingle, low rise sprawling structures in Estates/ Plantations

medium rise donation based hospitals in capital cities for the poor


Non StandardSingle, low rise sprawling structures in Estates/ Plantations

medium rise donation based hospitals in capital cities for the poor

• New Hospitals (Maternity/ Chinese)• GPs (Clinics)• Support Services• Nursing Homes

Integrated within commercialCentres for GPs,Nursing homes with the suburbs

• New Hospitals (Maternity/ Chinese)• GPs (Clinics)• Support Services• Nursing Homes

Integrated within commercialCentres for GPs,Nursing homes with the suburbs

Architecture

Customised design forhospitals

• More GPs Clinics•Pharmacies•Laboratory Services•X ray services•Teaching (Medical/Nursing schools)

Customised design forhospitals

• More GPs Clinics•Pharmacies•Laboratory Services•X ray services•Teaching (Medical/Nursing schools)

Homebased

PRIVATE HEALTHCARE ( URBAN BASED)

1957

Medical TourismAfter careHospices

Private Healthcare Facilities and Services Act 1998

Shops change to hospital

Purpose built hospitalShop lots to clinic and maternity homes

5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs


Healthcare Facility Healthcare Facility “…“….means any premises in which one .means any premises in which one

or more members of the public or more members of the public receive healthcare services..”receive healthcare services..”

Part 1, Preliminary, Section 2. Interpretation,Private Healthcare Facilities and Services Act 1998

Proposed HUKM teaching blockDamansara Arkitek


What is Government What is Government Healthcare FacilityHealthcare Facility

…” …” GHF Means any facility used or GHF Means any facility used or intended to be used for the provision intended to be used for the provision of healthcare services established, of healthcare services established, maintained, operated or provide by maintained, operated or provide by the Government but excludes the Government but excludes privatised or corporatised privatised or corporatised Government healthcare facilities;” Government healthcare facilities;”

Part 1, Preliminary, Section 2. InterpretationPrivate Healthcare Facilities and Services Act 1998


Private Sectors in the IndustryPrivate Sectors in the Industry

Island Hospital, Penang

Miriam Hospital,Penang

Upgrading and expansion


Private Sectors in the IndustryPrivate Sectors in the Industry

Mahkota Medical Centre, Melaka

Damansara Specialist Centre

Tower and podium, atrium/lobby, cafeteria, shops,Services Outpatient (general and Ssecialist) and Inpatient


The Public SectorThe Public Sector


Early post independent period1957-1970s

Colonial Period 1700-1957

Pre Colonial Period

Upgrading works1970s-1990s

Paperless HospitalsMasterplansTelemedicine late 90s-early 2000s


Non StandardSingle, low rise sprawling structures in small towns and

medium rise in capital cities


Non StandardSingle, low rise sprawling structures in small towns and

medium rise in capital cities

Standard Architecture Design for Nation Building

•Hospitals•Clinics•Support Services•Staff residence•Medical & Nurisng schools

Single, low rise sprawling structures in small towns

Standard Architecture Design for Nation Building

•Hospitals•Clinics•Support Services•Staff residence•Medical & Nurisng schools

Single, low rise sprawling structures in small towns

Greening Healing environmentup-grading, customised design building2007-to date

Architecture

New Standard Architecture Design for Nation Building

•District Hospitals•Clinics•Support Services•Staff residence•Teaching facilities

New Standard Architecture Design for Nation Building

•District Hospitals•Clinics•Support Services•Staff residence•Teaching facilities

Customised Architecture Design for Nation Building

Customised Architecture Design for Nation Building

High-rise, High-tech, art décor, post modern, retro, urban based, smaller land lots for Bigger Hospitals

homebased

PUBLIC HEALTHCARE NATION WIDE

1957 5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs

Conventional Procurement

Package Deal Procurement


Facility Planning NormsFacility Planning Norms

State Hospital at every StateState Hospital at every State Regional HospitalRegional Hospital Hospital for every districtHospital for every district Network of facilities for sub-specialtiesNetwork of facilities for sub-specialties

Community ClinicFor 2,000 to 4,000 population.

Rural Health Clinic

For 15-20,000 population

Health Centre


General GuideGeneral Guide Base on the principles of total planning Base on the principles of total planning

& development, the general guide to & development, the general guide to planning healthcare facilities are as planning healthcare facilities are as follows:follows:

Site planningSite planning Minimum area or acreage Minimum area or acreage Component of healthcare Component of healthcare

facilitiesfacilities Support facilities Support facilities


Site PlanningSite Planningi)i) Healthcare facilities should be provided Healthcare facilities should be provided

complete according to its hierarchycomplete according to its hierarchy:: a) a) HospitalHospital-includes general -includes general

hospital, district hospital, with hospital, district hospital, with oror without specialists. without specialists.

These are provided at state These are provided at state and district level.and district level.

b) b) Health CHealth Clinicslinics are provided are provided at at local level, andlocal level, and c) c) Rural Health ClinicRural Health Clinic is provided is provided at the rural areas. at the rural areas.


Site PlanningSite Planningii) The planning on the type of healthcare ii) The planning on the type of healthcare

facilities must be according to the region and facilities must be according to the region and the catchment area as shown in the the catchment area as shown in the Table ATable A;;

iii) The location of healthcare facilities should be iii) The location of healthcare facilities should be suitable and appropriate in terms of its suitable and appropriate in terms of its accessibility, quality of the environment, and accessibility, quality of the environment, and safe for the community; safe for the community;

iv) The healthcare site should be access by the iv) The healthcare site should be access by the network of roads and near to the public network of roads and near to the public transportation system;transportation system;


Site PlanningSite Planning

NoNo TypeType PopPop AreaArea

Hectare/acresHectare/acres

11 Rural Health ClinicRural Health Clinic 4000-50004000-5000 0.2/0.5 0.2/0.5

22 Health Centres Type I,II Health Centres Type I,II and IIIand III

15,000-20,00015,000-20,000 2.0/5.02.0/5.0

33 HospitalHospital 2 bed/10002 bed/1000

750 beds750 beds 375,000375,000 30.0/75.030.0/75.0

250 beds250 beds 375,000375,000 18.0/45.018.0/45.0

100 beds100 beds 50,00050,000 12.0/30.012.0/30.0

76 beds76 beds 38,00038,000 12.0/30.012.0/30.0

44 Dental ClinicDental Clinic At all Health CentresAt all Health Centres --

55 With TelemedicineWith Telemedicine According to According to requirementsrequirements

--

66 Referral HospitalReferral Hospital According to According to requirementsrequirements

--

TABLE A


Site planningSite planning

v) v) The location of a hospital need The location of a hospital need not not necessarily be in the town centrenecessarily be in the town centre to to avoid traffic congestion; but accessibleavoid traffic congestion; but accessible

vi) The location of hospital is not suitable vi) The location of hospital is not suitable at noisy and polluted areas; at noisy and polluted areas;

vii) The site planning of healthcare vii) The site planning of healthcare facilities must be in accordance to the facilities must be in accordance to the proposed and development strategy in proposed and development strategy in the local plan as well as approved by the local plan as well as approved by the state authority.the state authority.


Site Sizing and AcreageSite Sizing and Acreagei)i) The minimum size varies according to the The minimum size varies according to the

hierarchy of the facilities as shown in the hierarchy of the facilities as shown in the Table A;Table A;

ii)ii) The lot size should be able to The lot size should be able to accommodate the main building, the car accommodate the main building, the car park, the landscape, the support facilities park, the landscape, the support facilities as well as the probable expansion;as well as the probable expansion;

iii)iii) The acreage for healthcare facilities should The acreage for healthcare facilities should be adequate as to include planned activities be adequate as to include planned activities and the required components as per and the required components as per prescribed in accordance to its hierarchy. prescribed in accordance to its hierarchy.


Layout Plan and DesignLayout Plan and Design

i)i) The design of healthcare facilities The design of healthcare facilities should be a functional design to serve should be a functional design to serve as the health centres for all as the health centres for all communities; the building should communities; the building should reflect friendliness;reflect friendliness;

ii)ii) The design should take note the The design should take note the function and adjacency of the various function and adjacency of the various work area or departments base on work area or departments base on the workflow of patients and medical the workflow of patients and medical procedures so as not to obstruct; procedures so as not to obstruct;


Layout Plan and DesignLayout Plan and Designiii) iii) The The designdesign should consider the requirements should consider the requirements

of emergency treatment by providing of emergency treatment by providing emergency access for vehicles in cases of emergency access for vehicles in cases of emergencies; emergencies;

iv) Healthcare facilities design should consider iv) Healthcare facilities design should consider the local culture that is clean, organised and the local culture that is clean, organised and beautiful whilst establishing a community park;beautiful whilst establishing a community park;

v) The circulation for the facilities should be v) The circulation for the facilities should be clearly organised and without obstruction with clearly organised and without obstruction with provision for safe pedestrian crossing, the provision for safe pedestrian crossing, the disable, the elderly and children;disable, the elderly and children;

pam cpd 9th august 2008 1 presented by assoc. prof. datin ar. norwina mohd nawawi international...

Documents

health health

development of hospitals

pam cpd

historical development

introduction health

infirmity health

hospital architecture

state of complete physical