Ateneo de Davao University

Roxas Ave, Poblacion District, Davao City

AR 411 ARCHITECTURAL DESIGN 7 - COMMUNITY ARCHITECTURE

AND URBAN DESIGN

MAJOR PLATE 3 - 200-BED LEVEL 1 COMMUNITY HOSPITAL

(A Hospital Safe from Disasters)

Submitted by:
MANIPON, Chelsea Jade A.

Project Study and Architectural Programming

A.1

PROJECT STUDY

HOSPITAL

A hospital is a health care institution providing patient treatment with specialized staff and
equipment (Jack, 2014). Hospital resilience is a comprehensive concept derived from existing disaster resilience
frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential
medical services; recovery and adaptation. These domains were categorised according to four criteria, namely,
robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential
for an intellectual basis for an integrated approach to system development. This article (1) defines hospital
resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for
possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital
resilience to cope with future disasters (FitzGerald and Zhong, 2014).

1. Project studies on hospital design

According to the Department of Health these are the
GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH
FACILITIES

A hospital and other health facilities shall be planned and designed to observe appropriate
architectural practices, to meet prescribed functional programs, and to conform to applicable codes as part
of normal professional practice. References shall be made to the following:
P. D. 1096 National Building Code of the Philippines and Its Implementing Rules and Regulations
P. D. 1185 Fire Code of the Philippines and Its Implementing Rules and Regulations
P. D. 856 Code on Sanitation of the Philippines and Its Implementing Rules and Regulations
B. P. 344 Accessibility Law and Its Implementing Rules and Regulations
R. A. 1378 National Plumbing Code of the Philippines and Its Implementing Rules and Regulations
R. A. 184 Philippine Electrical Code
Manual on Technical Guidelines for Hospitals and Health Facilities Planning and Design. Department of
Health, Manila. 1994
Signage Systems Manual for Hospitals and Offices. Department of Health, Manila. 1994
Health Facilities Maintenance Manual. Department of Health, Manila. 1995
Manual on Hospital Waste Management. Department of Health, Manila. 1997
District Hospitals: Guidelines for Development. World Health Organization Regional Publications,
Western Pacific Series. 1992
Guidelines for Construction and Equipment of Hospital and Medical Facilities. American Institute of
Architects, Committee on Architecture for Health. 1992
De Chiara, Joseph. Time-Saver Standards for Building Types. McGraw-Hill Book Company. 1980

1 Environment: A hospital and other health facilities shall be so located that it is readily accessible to the
community and reasonably free from undue noise, smoke, dust, foul odor, flood, and shall not be located
adjacent to railroads, freight yards, children's playgrounds, airports, industrial plants, disposal plants.
2 Occupancy: A building designed for other purpose shall not be converted into a hospital. The location
of a hospital shall comply with all local zoning ordinances.
3 Safety: A hospital and other health facilities shall provide and maintain a safe environment for patients,
personnel and public. The building shall be of such construction so that no hazards to the life and safety
of patients, personnel and public exist. It shall be capable of withstanding weight and elements to which
they may be subjected.
3.1 Exits shall be restricted to the following types: door leading directly outside the building,
interior stair, ramp, and exterior stair.
3.2 A minimum of two (2) exits, remote from each other, shall be provided for each floor of the
building.
3.3 Exits shall terminate directly at an open space to the outside of the building.
4 Security: A hospital and other health facilities shall ensure the security of person and property within
the facility.
5 Patient Movement: Spaces shall be wide enough for free movement of patients, whether they are on
beds, stretchers, or wheelchairs. Circulation routes for transferring patients from one area to another shall
be available and free at all times.
5.1 Corridors for access by patient and equipment shall have a minimum width of 2.44 meters.
5.2 Corridors in areas not commonly used for bed, stretcher and equipment transport may be
reduced in width to 1.83 meters.
5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas located on the
upper floor.
5.4 A ramp shall be provided as access to the entrance of the hospital not on the same level of the
site.

6 Lighting: All areas in a hospital and other health facilities shall be provided with sufficient illumination
to promote comfort, healing and recovery of patients and to enable personnel in the performance of work.
7 Ventilation: Adequate ventilation shall be provided to ensure comfort of patients, personnel and public.
8 Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable sound
level and adequate visual seclusion to achieve the acoustical and privacy requirements in designated areas
allowing the unhampered conduct of activities.
9 Water Supply: A hospital and other health facilities shall use an approved public water supply system
whenever available. The water supply shall be potable, safe for drinking and adequate, and shall be
brought into the building free of cross connections.
10 Waste Disposal: Liquid waste shall be discharged into an approved public sewerage system whenever
available, and solid waste shall be collected, treated and disposed of in accordance with applicable codes,
laws or ordinances.
11 Sanitation: Utilities for the maintenance of sanitary system, including approved water supply and
sewerage system, shall be provided through the buildings and premises to ensure a clean and healthy
environment.
12 Housekeeping: A hospital and other health facilities shall provide and maintain a healthy and
aesthetic environment for patients, personnel and public.
13 Maintenance: There shall be an effective building maintenance program in place. The buildings and
equipment shall be kept in a state of good repair. Proper maintenance shall be provided to prevent
untimely breakdown of buildings and equipment.
14 Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall allow
durability, ease of cleaning and fire resistance.
15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be maintained for patients
and personnel, male and female, with a ratio of one (1) toilet for every eight (8) patients or personnel.
16 Fire Protection: There shall be measures for detecting fire such as fire alarms in walls, peepholes in
doors or smoke detectors in ceilings. There shall be devices for quenching fire such as fire extinguishers
or fire hoses that are easily visible and accessible in strategic areas.

17 Signage. There shall be an effective graphic system composed of a number of individual visual aids
and devices arranged to provide information, orientation, direction, identification, prohibition, warning
and official notice considered essential to the optimum operation of a hospital and other health facilities.
18 Parking. A hospital and other health facilities shall provide a minimum of one (1)
parking space for every twenty-five (25) beds.
19 Zoning: The different areas of a hospital shall be grouped according to zones as follows:
19.1 Outer Zone areas that are immediately accessible to the public: emergency service,
outpatient service, and administrative service. They shall be located near the entrance of the
hospital.
19.2 Second Zone areas that receive workload from the outer zone: laboratory, pharmacy, and
radiology. They shall be located near the outer zone.
19.3 Inner Zone areas that provide nursing care and management of patients: nursing service.
They shall be located in private areas but accessible to guests.
19.4 Deep Zone areas that require asepsis to perform the prescribed services: surgical service,
delivery service, nursery, and intensive care. They shall be segregated from the public areas but
accessible to the outer, second and inner zones.
19.5 Service Zone areas that provide support to hospital activities: dietary service,
housekeeping service, maintenance and motor pool service, and mortuary. They shall be located
in areas away from normal traffic.
20 Function: The different areas of a hospital shall be functionally related with each other.
20.1 The emergency service shall be located in the ground floor to ensure immediate access. A
separate entrance to the emergency room shall be provided.
20.2 The administrative service, particularly admitting office and business office, shall be located
near the main entrance of the hospital. Offices for hospital management can be located in private
areas.
20.3 The surgical service shall be located and arranged to prevent non-related traffic. The
operating room shall be as remote as practicable from the entrance to provide asepsis. The

dressing room shall be located to avoid exposure to dirty areas after changing to surgical
garments. The nurse station shall be located to permit visual observation of patient movement.
20.4 The delivery service shall be located and arranged to prevent non-related traffic. The
delivery room shall be as remote as practicable from the entrance to provide asepsis. The dressing
room shall be located to avoid exposure to dirty areas after changing to surgical garments. The
nurse station shall be located to permit visual observation of patient movement. The nursery shall
be separate but immediately accessible from the delivery room.
20.5 The nursing service shall be segregated from public areas. The nurse station shall be located
to permit visual observation of patients. Nurse stations shall be provided in all inpatient units of
the hospital with a ratio of at least one (1) nurse station for every thirty-five (35) beds. Rooms and
wards shall be of sufficient size to allow for work flow and patient movement. Toilets shall be
immediately accessible from rooms and wards.
20.6 The dietary service shall be away from morgue with at least 25-meter distance.
21 Space: Adequate area shall be provided for the people, activity, furniture, equipment and utility.

SPACE

AREA IN SQUARE
METERS

Administrative Service
Lobby
Waiting Area
Information and Reception Area
Toilet

0.65/person
5.02/staff
1.67

Business Office

5.02/staff

Medical Records

5.02/staff

Office of the Chief of Hospital

5.02/staff

Laundry and Linen Area

5.02/staff

Maintenance and Housekeeping Area

5.02/staff

Parking Area for Transport Vehicle

Supply Room
Waste Holding Room

9.29
5.02/staff
4.65

Dietary
Dietician Area

5.02/staff

Supply Receiving Area

4.65

Cold and Dry Storage Area

4.65

Food Preparation Area

4.65

Cooking and Baking Area

4.65

Serving and Food Assembly Area

4.65

Washing Area

4.65

Garbage Disposal Area

1.67

Dining Area
Toilet
Cadaver Holding Room

1.40/person
1.67
7.43/bed

Clinical Service
Emergency Room
Waiting Area
Toilet

0.65/person
1.67

Nurse Station

5.02/staff

Examination and Treatment Area with Lavatory/Sink

7.43/bed

Observation Area

7.43/bed

Equipment and Supply Storage Area

Wheeled Stretcher Area

4.65
1.08/stretcher

Outpatient Department
Waiting Area
Toilet

0.65/person
1.67

Admitting and Records Area

5.02/staff

Examination and Treatment Area with Lavatory/Sink

7.43/bed

Consultation Area

5.02/staff

Surgical and Obstetrical Service

Major Operating Room

33.45

Delivery Room

33.45

Sub-sterilizing Area

4.65

Sterile Instrument, Supply and Storage Area

4.65

Scrub-up Area

4.65

Clean-up Area

4.65

Dressing Room

2.32

Toilet

1.67

Nurse Station

5.02/staff

Wheeled Stretcher Area

1.08/stretcher

Janitors Closet

3.90

Nursing Unit
Semi-Private Room with Toilet

7.43/bed

Patient Room

7.43/bed

Toilet

1.67

Isolation Room with Toilet

9.29

Nurse Station

5.02/staff

Treatment and Medication Area with Lavatory/Sink

7.43/bed

Central Sterilizing and Supply Room

Receiving and Releasing Area

5.02/staff

Work Area

5.02/staff

Sterilizing Room

4.65

Sterile Supply Storage Area

4.65

Nursing Service
Office of the Chief Nurse

5.02/staff

Ancillary Service
Primary Clinical Laboratory
Clinical Work Area with Lavatory/Sink
Pathologist Area
Toilet
Radiology

10.00
5.02/staff
1.67

X Ray Room with Control Booth, Dressing Area andToilet

14.00

Dark Room

4.65

Film File and Storage Area

4.65

Radiologist Area

5.02/staff

Pharmacy

15.00

Notes:
1. 0.65/person Unit area per person occupying the space at one time
2. 5.02/staff Work area per staff that includes space for one (1) desk and one (1) chair, space for
occasional visitor, and space for aisle
3. 1.40/person Unit area per person occupying the space at one time
4. 7.43/bed Clear floor area per bed that includes space for one (1) bed, space for
occasional visitor, and space for passage of equipment
5. 1.08/stretcher Clear floor area per stretcher that includes space for one (1) stretcher.

2. Hospital design and planning characteristics.

According to the Department of Health, these are checklist for review of floor
plans - LEVEL 1 HOSPITAL

1 PHYSICAL PLANT
1.1 Administrative Service
1.1.1 Waiting Area
1.1.2 Admitting and Records Area
1.1.3 Administrative and Business Office
1.1.4 Staff Toilet

1.1.5 Parking Area for Transport Vehicle

1.2 Clinical Service
1.2.1 Emergency and Outpatient
1.2.1.1 Waiting Area
1.2.1.2 Toilet
1.2.1.3 Nurse Station
1.2.1.4 Consultation Area
1.2.1.5 Examination and Treatment Area with Lavatory/Sink
1.2.1.6 Equipment and Supply Storage Area
1.2.1.7 Wheeled Stretcher Area
1.2.2 Birthing Room
1.2.2.1 Birthing Area
1.2.2.2 Scrub-up Area
1.2.2.3 Newborn Area with Lavatory/Sink
1.2.2.4 Equipment and Supply Storage Area
1.3 Nursing Service
1.3.1 Nurse Station
1.3.2 Patient Room
1.3.3 Toilet
2 PLANNING AND DESIGN
2.1 Floor plans properly identified and completely labeled
2.2 Conforms to applicable codes as part of normal professional service:
2.2.1 Exits restricted to the following types: door leading directly outside the building,
interior stair, ramp, and exterior stair
2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the building
2.2.3 Exits terminate directly at an open space to the outside of the building
2.2.4 Minimum of one (1) toilet on each floor accessible to the disabled

2.3 Meets prescribed functional programs:

2.3.1 Main entrance of the infirmary directly accessible from public road
2.3.2 Ramp for clinical, nursing and ancillary services located on the upper floor
2.3.3 Administrative Service
2.3.3.1 Administrative and business office located near the main entrance of the
infirmary
2.3.4 Emergency and Outpatient
2.3.4.1 Located in the ground floor to ensure easy access for patients
2.3.4.2 Ramp for wheelchair access
2.3.4.3 Nurse station located to permit observation of patient and control of
access to entrance, waiting area, and treatment area
2.3.4.4 Separate toilets for patients and staff
2.3.5 Birthing Room
2.3.5.1 Located and arranged to prevent non-related traffic through the room
2.3.5.2 Scrub-up area recessed into an alcove or other open space out of the main
traffic
2.3.6 Separate toilets and wards for male and female patients
2.3.7 Nursing Service
2.3.7.1 Nurse station located and designed to allow visual observation of patient
and movement into the nursing unit
2.3.7.2 Toilet immediately accessible from each room in a nursing unit

3. Resilient design approaches

According to the UNISDR (United Nations Office for Risk Reduction),
The following are 10 basic facts to know about keeping hospitals and health facilities safe from disasters:
Many factors put hospitals and health facilities at risk:

Buildings: The location, design specifications, and resilience of the materials used, all
contribute to a hospitals ability to withstand natural hazards.

Patients: In normal times, health facilities are occupied 24 hours a day by highly
vulnerable people, and are often full to capacity. In disaster situations, damage to hospital
components compounds patient vulnerability, as well as increasing the number of patients.

Hospital beds: Disasters often cause the loss of hospital beds, frequently just as the
demand for emergency care increases.

Health workforce: The loss or unavailability of health workers compromises care for the
injured. Hiring outside personnel to sustain response capacity adds to the overall
economic burden.

Equipment: Damage to non-structural elements often surpasses the cost of damage to the
building. Even less costly damage can still force a hospital to halt operations.

Basic lifelines and services: A hospitals ability to function relies on lifelines and other
basic services such as electrical power, water and sanitation, and waste management and
disposal. The loss of even some services can affect the entire health facility.

Components of a hospital or health facility are typically divided into two categories:

Structural elements: those essential elements that determine the overall safety of the
system, such as beams, columns, slabs, load-bearing walls, braces or foundations.

Non-structural elements: all other elements that enable the facility to operate. They
include elements such as water heaters or storage tanks, mechanical equipment, shelving
and cabinets and lifelines. In the case of hospitals, 80 per cent or more of the total cost of
the facility can be the price of non-structural components.

Functional collapse, not structural damage, is the usual reason for hospitals being put out of
service during emergencies:

Functional collapse occurs when the elements that allow a hospital to operate on a day-today basis are unable to perform because the disaster has overloaded the system. These
include: architectural spaces such as laboratories or operating theatres; medical records;
medical and support services; and administrative processes (such as contracting,
procurement, and maintenance routines). Although the measures necessary to prevent a
functional collapse (such as contingency planning, improved organization and staff
training) require a significantly smaller financial investment, they nonetheless remain a
major challenge

Hospitals and health facilities can be built to different levels of protection:

Life safety is the minimum level of protection and is the most common approach to
protection in the construction of health facilities;

Investment protection is designed to protect all or part of the infrastructure and

equipment, although the facility itself may stop functioning. This level of protection
ensures that the facility resumes operations within a reasonable timeframe and cost;

Operations protection, which is the most costly level, includes life and investment
protection but also seeks to ensure the facility continues to function after a disaster.

Making new hospitals and health facilities safe from disasters is not costly
Building a hospital is a significant capital investment. In calculating the cost, one must include
both the structure itself and the non-structural elements (non-structural elements account for
about 80 percent of the total cost). It has been estimated that the incorporation of mitigation
measures into the design and construction of a new hospital will account for less than 4 percent of
the total initial investment.

Field hospitals are not necessarily the best solution to compensate for the loss of a hospital

or health facility
Field hospitals have been used successfully in complex disasters (civil conflicts and wars), but
experience in the aftermath of disasters caused by natural hazards in developing countries has
shown these extremely expensive solutions to be not satisfactorily cost-effective.

Seeking the right expertise: a check consultant

A check consultant is an independent consultant who, on behalf of a client, ensures that norms
and building standards are in place. Check consultants can be contracted to oversee the
construction of any building, but their thorough knowledge of building codes and natural hazard
mitigation measures are particularly important to ensuring the disaster safety of critical facilities
such as hospitals.

Building codes are of utmost importance

One of the earliest mentions of the importance of building codes is found in Hammurabis Code2 :

232: he [the builder] shall make compensation for all that has been ruined, and
inasmuch as he did not construct properly this house which he built and it fell, he shall reerect the house from his own means.

Creating safe hospitals is as much about having vision and commitment as it is about actual

resources
The responsibility of creating safe hospitals must be shared among many sectors: planning,
finance, public works, urban and land-use planning, together with the health sector. The political
will to make this happen must match the knowledge that already exists.

10

The most costly hospital is the one that fails!

4. Situational analysis and visual survey of the proposed site.

Location: Carlos P. Garcia Highway, Davao City
Zone: The area near the road is on the Major Commercial Zone (C-2) while the lot in its back portion in
on the Low density residential zone (R-1)
Neighborhood Context: Its neighborhood context in the front area are commercial buildings while on
its rear and side areas are residential buildings.

ACTUAL PICTURES:

( view from the other side of the street - from phoenix gasoline station and City Hardware)

(view from the overpass)

(the lot on the left site is the site this is the road is going to the Bangoy international airport)

(sidewalk area)

A.2

ARCHITECTURAL PROGRAMMING

1. Statement of Goals and Objectives

To design a sense of place
To apply sustainable design & environmental conservation
To create a lay out that suits its environment and its users
To build a cost saving, efficient and resilient place
To give accessibility, comfort and relaxation to all of its users
To build a structure that could protect and function well during disaster.

2. Design Considerations
1. Resilient design structure
2. Architectural relationships with the environment and ecology.
3. Design for communities in public design with an understanding of site development and
planning.
4.Various human behaviors (socio-cultural factors) related to the project
5. Energy efficiency in the buildings
6. The efficient use of materials and the nature of site for energy conservation and a sustainable
built environment.

3. Design Concept and Philosophy

Hospitals are structure built to give care to the people who need medical attention. Yet unlike its
meaning, the design concept of this project is to go beyond further the usual care a hospital could provide.
Using the latest resilient design methods, the structure could provide both state-of-the-art design and
medical facilities. The facade is water and mountain inspired. Water because it symbolizes cleansing. On
the other hand, mountain because it symbolizes the obstacles that a patient is experiencing. Furthermore,
it aims to inspire everyone to hope that a person has a chance to conquer its obstacle if he or she would
really want to. Lastly, its circulation or floor plan is inspired by an image of a mother carrying a baby. Its
design concept is based on resilient design and modern architecture. It also aims to boost the connection
between the user and the environment through the use of elements in order to give a dynamic impact to its
users through aesthetic design and efficient space planning. Its concept is to create an active and livelier
environment, a significant aura and a sense of place to everyone.

" Resilient Design is the best medicine."

Being in a world that is affected by climate change, especially to our country, Philippines, which
is known to be vulnerable in terms of disasters, it is already the right time to use resilient design. This
design philosophy aims to be a source of strength and hope. A structure that could provide more than
being a dwelling place. It aims to make people and nature be more connected through visual, audible and
physical elements that urban design could give. It aims to change our unhealthy surrounding with a more
warm and cozy atmosphere.

4. Project Requirements
-According to Philhealth, these are the requirements to be accredited as a Level 1 Hospital

Emergency hospital
initial treatment for cases that require immediate treatment and that
provides primary care for prevalent diseases in the area
general medicine, pediatrics, minor surgeries, and non-surgical
gynecology
primary clinical laboratory, pharmacy and first level radiology
nursing care for patients needing minimal supervised car
-Ample Parking space
- Administration, Service Facilities (toilet, solid waste mgt, security etc.)

- Flora and fauna/ Landscaping/ Promenade (Park Area)

- Common Community Area (Activity Ground)
- Others deemed necessary
5. Site Analysis Plan/s (Lot Details/ Bearings, Utilities, Topography and Climate)

Location: Carlos P. Garcia Highway, Davao City

Zone: The area near the road is on the Major Commercial Zone (C-2) while the lot in its back portion in
on the Low density residential zone (R-1)

Vicinity Map:

____________________________________________________________________________________
POINTS

DISTANCE MEASUREMENT

BEARING

162.00 m

N 42.9 E

131.00 m

N 57.3W

C
D

138.75 m
129.00 m

S 42.9W
S 47.1E

Topography: The site is not a flood prone area. It is located on the highland part of the city.
Type of Soil: Loam soil ( It is good for agriculture)

Hydrology: There are no bodies of water near the site

Climate: Davao City enjoys a mild tropical climate
Vegetation: The site is filled with different plants and trees specifically grass and grains.
Man-made Features: Billboards

This site was chosen for the proposed project for its accessibility
and ample space. Aside from it, the site in the Buhangin Area
does not still have an existing hospital that could cater to a lot of
people. Thus, this would be good for it could contribute great to
the community.

6. Site Land Use Distribution Plan (Matrixes & Bubble Diagrams)

This project aims to provide the following:

-medical/health facilities - state of the art

-holistic care
- coffee shop or food establishments
- oasis; praying area
- great views of the setting
-welcoming environment
-Rooftop garden

SOURCES:

Department of Health. (2007). Checklist for review of floor plans level 1 hospital. Retrieved September
11, 2015 from: http://www.doh.gov.ph/system/files/review_level1hospital.pdf
Department of Health. (2004). Guideline in the planning and design of a hospital. Retrieved September
11, 2015 from: http://www.doh.gov.ph/system/files/planning_and_design_0.pdf
Department of Health, Philippines and the World Health Organization. (2015, September 10). Hospitals
Should be safe from Disasters. Retrieved September 11, 2015 from: http://www.eird.org/publicaci
ones/safe_hospi tals_manual.pdf
FitzGerald, G. and Zhong, S. (2014). Validation of a framework for measuring hospital disaster resilience
using factor analysis. Retrieved September 11, 2015 from: http://www.ncbi.nlm.nih.gov/pmc/articl
es/PMC4078582/
Jack, C. (2014). Care Institution Providing Patient Treatment. Retrieved September 11, 2015 from:
http://sinhalacartoonworld.blogspot.com/2014/10/care-institution-providing-patient.html
Phil health. (2011).What are hospital levels, as used by philhealth. Retrieved from:
http://www.healthphilippines.net/2011/08/hospital-levels-philhealth/
UNISDR - United Nations Office for Risk Reduction. (2008). 10 basic facts to know. Retrieved from:
http://www.unisdr.org/2009/campaign/pdf/wdrc-2007-2008-10-basic-facts.pdf