LITERATURE STUDYINTRODUCTIONHealth care delivery is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care can contribute to a significant part of a country's economy.

CLASSIFICATION Primary care refers to the work of health professionals who act as a first point. example, General physician etc. Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists etc. Tertiary care is specialized consultative health care that has personnel and facilities for advanced medical investigation and treatment usually for inpatients. Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery etc.

1.1 HOSPITALA Hospital is a health care institution providing patient treatment with specialized staff and equipment. Hospitals can either be Government owned or Private. Many Government hospitals also function as Medical colleges. Building a hospital today is a very complicated procedure. A large number of or hospitals have been built in crowded areas and with increase in modernization of medical equipment and advances in diagnostic and thereapeutic technology it is inevitable that need for increased space will arise. In building new hospitals it is necessary to resort to very careful and detailed planning, as hospitals are very expensive to build and run, and once it build cannot be easily re modelled without further considerable expenditure. Fortunately in the last three decades, mainly due the complexity of modern hospital and increasing demand in aspects such as treatment and care facilities, maintenance costs effective planning considerations have to be adopted.Hospitals in India can be classified on the basis of studies based on their ownership pattern or the speciality of the hospital. General Hospitals: A Hospital which is set up to deal with many kinds of disease and injury not specializing in the treatment of any particular illness or patient of a particular sex or age group. District hospitals: A district hospital is the major health care facility in its region, with large numbers of beds for intensive care and long-term care. Specialty Hospitals: Types of specialized hospitals include trauma centres, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopaedic. Multi-Specialty Hospitals: These are hospitals that have various specialties in one campus. Teaching hospital: It combines assistance to people with teaching to medical students and nurses and often is linked to a medical school, nursing school or university.

Main Functional components : Patient care facilities facilities those involves the care and well being of the patients Administration - they see through the successful functioning of the whole hospital Technical services these are the supporting systems which take care of the efficient running of the hospital Classification of patients Emergency Urgent Non emergency Vertical Layout

The vertical layout of the hospital should be structured to allow easy patient flow and services.

Suggested Vertical Cross-sectional Distribution of Hospital Spaces Source; Neufert, Architects Design Data

CANCER CENTER'S http://www.healthcaredesignmagazine.com Oncology is a branch of medicine that deals with tumours. Cancer care design's have traditionally been functional hygiene, efficiency, and flexibility for changing technology. While functionality is essential to any healthcare environment, buildings that provide cancer care must encompass characteristics that address the distinctive aspects of the cancer patient, family and the care team, which are unique.Main functions of a cancer hospitalIn general, cancer treatment can be broken into three basic, concentrated groups: medical oncology, surgical oncology, and radiation oncology.

DIAGNOSIS: The diagnosis of any cancer in a person (pathology),Occasionally, a physical examination may find the location of a malignancy.eg: Endoscopy, X-rays, CT scanning, MRI scanning, ultrasound etc. THERAPY: Certain cancers will require immediate admission and chemotherapy, while others will be followed up with regular physical examination and blood tests. e.g. surgery, chemotherapy, radiotherapy and other modalities. FOLLOWUP: Taking care of cancer patients after successful treatment. PALLIATIVE CARE: Palliative care is an important aspect of a cancer care that facilities patients with terminal malignancies and address patients who have been diagnosed as terminal and make their environment comfortable for them to spend their last days. Hence these hospitals should create an environment that fosters patient health, care and satisfaction including a feeling of hope those who step in.Cancer treatment affects essentially three groups: The doctors, patients and their loved ones. Cancer Patient's Every cancer patients journey is personal no two patients or diagnoses are exactly alike. The disease has no bias as to age, ethnicity, or gender. However, many cancer patients do share similar treatment experiences that include an array of physical trials, emotional challenges, and spiritual journeys. Changes in physical appearance are a common result of chemotherapy and other cancer treatments. Many patients experience hair loss, scars, skin changes, weight loss or gain, sensitivity to smells and temperature, and loss of muscle tone, creating limitations in activity and altering familiar daily life. People who underwent diagnosis and treatment have the longest inpatient stays as these groups of patients are given immunosuppressive drugs as a part of their treatment. These long stays and isolation can be very depressing for them. It is important to design uniquely responsive places that have the potential to aid the healing process and to provide a place that reinforces respect, dignity and security.Caregivers Role Of Hospital Staff A focused and compassionate care team has proven to be one of the best remedies for patient recovery and healing. For each unique patient, the mix of cancer care giving team members will vary and may include many different specialists, such as surgical oncologists, medical (chemotherapy) oncologists, radiation oncologists, oncology residents, internists, physician specialists, physicists, oncology nurses, nurse navigators, nursing techs, radiation therapists, radiology technicians, physician assistants, pharmacists, phlebotomists, nutritionists, social workers, chaplains, psychotherapists, massage therapists, meditation therapists, researchers, geneticists etc.

Role of Family Also referred to as informal caregivers, family caregivers provide a complex array of support tasks that extend across physical, psychological, spiritual, and emotional domains. Family caregivers play an important role in the management of cancer during diagnosis, treatment ;enlisting their cooperation and including them as the unit of care from the outset are considered critical ingredients to effective cancer management. Most oncology teams recognize this and try to include family caregivers in treatment planning, decision making, and implementation. Surveys have shown that the perception of quality care is directly related to the interaction between patients and caregivers. Caregivers have a direct impact on patient experience therefore, the needs of caregivers must not be overlooked. Designing environments for caregivers should enable them to provide a higher level of personal care to cancer patients. Considering the physical and emotional needs of caregivers, as well as their activities, will enhance the design

CANCER

1.3 WHAT IS CANCER? Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. The most common causes of cancer death are cancers of: lung (1.59 million deaths) liver (745 000 deaths) stomach (723 000 deaths) colorectal (694 000 deaths) breast (521 000 deaths) oesophageal cancer (400 000 deaths)

SATGES OF CANCERCancer staging can be divided into a clinical stage and a pathologic stage. Overall Stage Grouping is referred with numerals I, II, III, and IV (plus the 0) http://www.cancerinstitute.org.auCANCER STAGETYPE OF TREATMENT

STAGE 0,1SURGERY

SATGE 2,3,4CHEMO,RADIATION,SURGEY

1.6 TREATMENT METHODS OF CANCER:TypeProcess

ChemotherapyInducing antineoplastic drug at the treatment regiment

Surgerysurgical management to remove cancerous cells

Radiation TherapyUsing radiations on the effected part, less painful

Other TreatmentInducing hormones that binds the cancer cells and develop antigens

http://www.cancerinstitute.org.au

1.7 CANCER A WORLD THREAT Cancer is the second most common disease after cardiovascular disorders for maximum deaths in the world. The word still conjures up deep fears of a silent killer that creeps up on us without warning. Cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012. Prevalence estimates for 2012 show that there were 32.6 million people (over the age of 15 years) alive who had a cancer diagnosed in the previous five years. The number of new cases is expected to rise by about 70% over the next two decades. According to reports by W.H.O. one out of three women and one out of four men are prone to getting cancer in the world. http://www.who.int

1.8 CANCER SCENARIO IN INDIA Cancer is one of the leading causes of death in India, with about 2.5 million cancer patients, 1 million new cases added every year and with a chance of the disease rising fivefold by 2025. During last one decade, about 70% cancer cases have been diagnosed and treated with survival of a few patients. About 6% of all deaths in India are due to cancers which contribute to 8% of global cancer mortality.

Based on the data from 2004 to 2010, predictions have been made for cancer cases in 2015 and 2020. With the numbers seen as increasing, the battle against cancer in the future is only going to get more and more monumental.

1.9 IMPACT OF CANCERS The impact of cancer in India is far greater than mere number of cancer cases. If detected early, treatment is effective and cheaper. However, if detected late, it is more expensive (can even lead to bankruptcy) and also reduces chances of survivals. Its diagnosis causes immense emotional trauma and its treatment a major economic burden. The initial diagnosis of cancer is perceived by many patients as a grave event with more than one third of them suffering from anxiety and depression. Cancer is equally distressing for family as well. It could affect both familys daily functioning and economic situation. Several research's had found that having direct access both visual and physically to the outdoors helps speed up the recovery process for most cancer patients.

1.10 NEED OF CANCER CARE CENTER'S According to Boston Consulting Group Study, 70-80% cancer cases in India are diagnosed late and 60% patients do not have access to quality treatment. There are only 300+ cancer centers in India while studies further suggests that 600 more required to meet the demand by 2020. In India, it has been noticed that often patients travel from fringes of the country to the perceived treatment centers at metropolitan cities. This results in overcrowding which can be solved by equal distribution of quality hospitals. India is also increasingly becoming a destination of medical tourism.HEALING ENVIRONMENT1 INTRODUCTION The awareness of positive influences of outdoor and indoor environment on patients' healing process has been present long back in hospital architecture. Recently developed and integrated healthcare systems are more focused on patients' needs regarding the effects of treatments and services on their satisfaction. With the aim to reduce costs of medical therapies without sacrificing their quality, this new approach resulted in a substantial shift in planning and designing of both indoor and outdoor hospital spaces. The importance of creating a concept of patient-focused hospital as therapeutic environment which provides physical, emotional and spiritual comfort to all groups of users. This shift in practice does not apply only to indoor spaces, but to outdoor surrounding as well. Healing is not the same as curing, which is about fixing problems, eradicating disease, and decreasing symptoms. People can be healed even if they are not cured. Conversely, people may be cured but not healed. Thus, healing environments are designed to promote harmony of mind, body, and spirit.

1.1 The Healing Environment Asian Journal of Environment-Behaviour Studies,Volume 2,, http://www.minnesotamedicine.com, HEALING ENVIRONMENTS IN RADIOTHERAPY RECOMMENDATIONS REGARDING HEALING ENVIRONMENTS FOR CANCER PATIENTS Interests in healing environment backdated since about 2,300 years ago, but were known in different approaches, such as holistic and spiritual. They were more commonly termed as Complementary or Alternative Medicine. Healing environment can be described simply as the overall environment (both physical and non-physical) created to aid the recovery process. In contrast to curing, healing is a psychological and spiritual concept of health. Since perception is also psychological, there is a likelihood of a relationship between healing and the physical environment. A patient environment designed to impart wellness and comfort in all dimensionsmind, body and spiritis as vital to cancer care as science and technology. Creating an environment that would be supportive, friendly and less stressful for patients and their visitors, and simultaneously more creative and restorative for hospital staff are the key elements and issues that need to be addressed during planning of hospital spaces. Implemented effectively, healing-focused and evidence-based design can potentially improve a cancer patients ability to cope with the emotional and physical aspects of the disease and its treatmentand, ultimately, increase patient satisfaction.

1.2 History of healing environments The very first hospitals emerged around 300 BC in Greece and were located in certain temples. As the Greek believed in the divine power of nature, these temples were generally located in forested locations near springs and contained dormitories with open entry to the south (figure 1). The presence of nature, water in particular, was considered essential.THE GEREEK HEALING GARDEN In the middle Ages, healthcare was usually provided by religious institutions. The nuns and monks who treated patients believed in Gods ultimate authority over peoples health. Intending to help the sick make a connection with God, the monasteries usually had a central courtyard on which the patients had a view (figure 2). Peace and quiet were also highly valued. In the 18th century, the pavillion style hospital emerged (figure 3). This hospital design emphasised the benefits of nature, such as fresh air, sunlight, green surroundings and a peaceful environment.MONASTERY COURTYARD

Garden Lodge of the Royal Hospital, Dublin, 1730. In the late 1970s, interest in the effects of the environment on healing and health outcomes was renewed. Healing gardens, fish tanks, waterfalls and gentle sounds were provided to connect patients, family and staff with the relaxing and healing aspects of nature.

The 20th century was the period of technological advances in both medical science and building construction. The recognition of possible restorative benefits of nature has started to disappear as the emphasis of hospital design shifted towards increasing staff's efficiency and away from creating a therapeutic environment. Thus, hospitals erected during the Modern Movement resemble high-rise office buildings, with large parking lots that replaced traditional gardens

Cornell Medical Center, New York, 1933; HpitalBeaujon, inspired by the American hospital Clichy,

1.3 BENIFITS OF CREATING POSITIVE HEALING ENVIRONMENT The greatest impact on the hospital design in the past century, was evidence regarding the effects of treatments or services on patients' satisfaction gained much more importance. All hospital users experience positive health outcomes from connection to natural environment, access to daylight and landscape views and also interior environment created at various spaces such as treatment areas, patients wards etc. These spaces should offer an experience that they might have a significant impact on one's health improvement. To illustrate, in an evaluation of four hospital gardens in San Francisco, a team of experts used a combination of behavioural observation and interview methods. The results showed that, after spending time outside, 79% of the patients felt "more relaxed and calmer", 25% sensed "refreshed and stronger", 22% were "able to think and cope" and only 5% did not feel any particularchange.1.4 USER GROUPS AND THEIR NEEDS There are three distinctive groups of users of both indoor and outdoor hospital spaces patients, employees and visitors, each having its own requirements and patterns of use. Patient group which consists of various categories depending on type of patients' disabilities, their length of stay (e.g., short-term and long-term inpatients or outpatients) and physical and psychological needs (e.g., paediatric, rehabilitation, radiation therapy ,post-surgery patients, those with sunlight sensitivity or with immune suppression). Employees, varying from the medical to administrative and supporting staff, are critical group of users since they spend every working day within the hospital environment. All of them use outdoor space as an effective means for achieving a restorative escape from stressful jobs and aversive conditions in the hospital. Visitors as the third user group are also in need of positive distractions while spending time with their family members or friends. These visits are frequently reassuring, but may as well be emotionally intense, and thus require a supportive environment. Healing environments are associated with certain physical elements - such as access to natural daylight, views of nature, and fresh air - as well as social and psychological elements - such as a sense of control, positive attitude and hope, and respectful medical staff.

1.5 TYPES OF USER EXPERIENCES It is essential to base them on the premise that the hospital outdoor spaces need to accommodate various types of activities and experiences which are in a close relation to the users' particular needs. In brief, they should be planned according to following requirements:1. to create opportunities for movement and exercise;2. to offer a choice between social interaction and solitude;3. to provide both direct and indirect contacts with nature and other positive distractions. Active experiences are both physically and psychologically beneficial since they improve patient's fitness, reduce stress and depression. In addition, physical therapy and rehabilitation undertaken in a natural environment may enhance positive results of various medical treatments. Given that, while staying in the hospital, a majority of patients is constantly under a strict regime, they frequently experience a loss self-esteem or control over their lives. Therefore, passive experiences of being able to select between seeking privacy and socially interacting may be beneficial from a psychological point of view. Direct or indirect sensory experiences of connection with nature and positive distractions involve stimulating one or more of five senses, calming the mind, reducing stress and encouraging person's own healing resources. This also applies to indirect contact with outdoors by viewing a distant and nearby nature through the window of patient's room.1.6 PHYSICAL FACTORS -GENERAL DESIGN CONSIDERATIONS FOR PLANNING OUTDOOR AREAS Hospital's site is certainly one of the most significant generators of its form in many aspects. In an ideal case, optimal distribution of the total site area of a hospital complex should be the following: 30% for the buildings, 15% for internal communication routes and parking, 50% for vacant area (25-30% in case of hospitals with a limited capacity for future growth) out of which 10% is reserved for recreational areas. While planning suitable locations for different types of outdoor areas, there are several issues that need to be taken into account, such as: environmental factors (e.g., orientation, wind exposure, views); distance from distractions (e.g., urban noise, parking lots, mechanical systems); physical configuration of the complex; internal traffic system and its access points; specific needs of different user groups; etc. Proper acknowledgment and implementation of these factors may generally enhance beneficial value of the outdoor space.1.7 Variety of outdoor healing spaces and their interrelation Series of diverse smaller squares and meeting points conventionally located to one another can create a cozy atmosphere and variety of experiences rather than a large one. These spaces should offer a choice places for both group and solitary occupancy; places in the sunlight or shade; places to pause and experience natural surrounding; places with open or closedviews, etc. Meditation square in the Massachusetts General Hospital, Boston Emphasis on natural features as grounding points, such as the use of plants, rocks, wood or water, can only be beneficial to recovery. Art, represents "a psychological component of the auto-immune system that gives expression to the healing process", implementation of carefully chosen art pieces should also be encouraged.

Sculpture Garden in the Betsheda Rehabilitation Center, St. Paul Environments that are mysterious or complex to understand can be interesting and challenging to the healthy, but to ill they usually provoke counter-indicated effects. Green areas The key element of a positive healing and therapeutic environment is the presence of greenery. In general, exposure to nature can have a significantly beneficial effect on people's emotional state - "the more the setting evoked an image of a rich, green garden, the more it was used and appreciated as a place to recoup in complete to the high-tech, hygienic, fluorescent-lighted hospital interior". According to the Green Guide for HealthCare, implementation of healthy ecosystems in hospital outdoor spaces has significant social, psychological and physical benefits derived from physical and visual connection to natural environment .This guide also suggests the following formula for the calculation of the required green area: Natural Habitat Area = (Site Area x Site Size Factor) / Floor Space Ratio, where Floor Space Ratio = Gross Constructed. Area including all service spaces and excluding parking areas / Site Area and Site Size Factor = (Site Area / Site Area) 10 (usually around 0.15). Meditation Garden, City of Hope Cancer Center, Peter's Garden of Hope,Fletcher-Allen Hospital Duarte Burlington

Plant material A selection of plant material for hospital outdoor spaces should be carefully made in order to associate certain users' needs, particularly patients' requirements, to plants' specific characteristics and features. Furthermore, the use of plants with a higher phyton cide emission, like oak and pine trees, may contribute to better treatment outcomes. Green roofs use may influence and enhance the general quality of healthcare environment. Depending on the hospital's physical configuration, one of the options in case of limited site area is to create accessible or inaccessible roof gardens visible from the upper floors of higher buildings in the vicinity. Not only that green roofs accommodate places for contemplation and relaxation, but they also minimize energy consumption they reduce heating loads by adding mass and thermal resistance value and lower cooling loads through evaporation. Viewing roof garden, Harrison Memorial Hospital, Bremerton

View out The outdoor hospital areas should be visible from patients' rooms, interior public spaces and corridors, for both security and medical purposes. View out is also psychologically therapeutic, since it reduces feeling of isolation and claustrophobia by providing a constant contact with the outside world.

View from a patient's room, Hitchock Medical Center, Darmouth Successful way finding system is a powerful navigation tool which provides necessary information, enabling decision making and planning of routes. Style of communication elements, including material, color, contrast and text, has to be consistent, carefully implemented in an overall hospital design and should not be tampered out with.

1.8 VARIETY OF INDOOR HEALING ENVIRONMENTS AND THEIR INTERACTION LIGHTING1. Light is the most important element of healing environments, proper lighting is an important issue for any healthcare settings.2. Artificial lighting , indirect lighting, table lamps and shimmering lamps makes the environment more natural and cheerful as these lightings are generally used in home. Areas where patients might pass through while lying on a bed, the light wont shine in their eye. Indirect lighting also gives the space a much warmer feeling. Indirect lighting in a corridor at the hospital

3. Natural daylight, on the other hand, is often reported more beneficial than electric light for psychological comfort.4. Patients who are exposed to increased amounts of natural sunlight during the recovery period after surgery experience less stress and pain, use less analgesic medication, and produce less pain medication costs. FRESH AIR1. Fresh outdoor is recommended, as this can influence temperature and humidity. Where as poorly ventilated buildings can add to uncomfortable symptoms of sickness, good ventilation can improve health care quality. NATURE FROM INSIDE1. It is also vital to provide natural elements inside the building, especially in circumstances where logistics or the patients health status make going outdoors more difficult. Elements like indoor plants or an aquarium are simple solutions to bring nature indoors.2. Besides having a direct influence on the air quality, indoor plants may affect health through psychological mechanisms, such as mood improvement or reduction of stress and pain.

Dense array of indoor plants at the hospital MUSIC 1. Provision of music in healthcare settings, as well as providing a way to distract from other noise, can calm and soothe the patients mood.2. Music therapy effectively reduces anxiety, stress and the experience of pain. HOMELY ATMOSPHERE 1. It is important to design hospital environments in a homely fashion, day treatment for cancer patients should provide a pleasant environment with a living room feeling to it.2. The treatment rooms at the control hospital are designed with round screensaround the radiation machines. Behind these screens, additional equipment such as treatment masks is located, so that patients do not have to see all the equipment. Furthermore, these rooms do not have doors, so that patients dont feel locked up during treatment. Instead, radiation is prevented tocome into public areas of the department through curved corridors made of thick walls.

Screens around treatment machine (left) and corridor toward treatment room (right) at the hospital Art and positive distractions1. Healthcare settings often provide art and decorations in order to improve theaesthetics of the environment and provide visual distractions.2. In addition, pictures of natural environments featuring water, the ocean, mountains, and open views of landscapes tend to be appreciated by patients. Large painting of natural scene3. Providing distractions is also very important in radiotherapy treatment rooms, since patients have to lie still while being alone in a room with a big machine, which can feel threatening and produce anxiety.4. For instance at the control hospital, this is addressed by decorating the ceilings of treatment rooms with a screen with many small holes, through which tiny shining lights simulate a starry sky.5. Another method is to provide posters on the ceiling, or to provide other visual distractions, such as light diffuser panels or virtual skylights.

Starry sky above the treatment machine Light diffuser panel in treatment room

COLOUR THERAPY1. Colour in healthcare settings, can make the environment seem less institutional, and that warm colours make objects look heavier than cool colours. Furthermore, cool colours tend to be relaxing while warm colours offer stimulation.2. It is recommended to use warm ,soft, natural colours in hospitals.

1.9 Social and psychological factors Feeling in controlIn healing environments, it is important to restore a certain sense of control. as people are 100% dependent on the doctor or nurse. An important means of establishing this is to involve patients in decision making processes. This may concern decisions regarding the hospital where patients are being treated and the preferred treatment methods. PrivacyPrivate rooms are recommended because they reduce risk of infection, provide privacy and increase patients satisfaction. Family members can help for instance with washing, dressing, feeding and bringing the patients to bed. Access to informationPatients have a need for relevant information which they can understand and process .It is necessary to provide possibilities to ask questions for the required information. Being treated with respectIt is vital to ensure that patients are receiving personal attention and are being treated with respect, so that they feel taking seriously. Counselling and support groupsProviding patients with the opportunity to receive psychological therapy or counselling may be an important step towards enabling a more positive outlook on their situation and maintain quality of life. Hospitals should therefore provide a link to link patients to in-house or external support groups, confessional support services. Love, care and compassionThe vision of the radiotherapy department is to take care of patients in the same way as if for a family member, which means that a caring and warm atmosphere not only created through the environment, but also through the attitude and behaviour of the radiotherapy staff. Integrated medical teamThe staff contribute to the creation of their own working environment and the clinics identity, which makes them feel more at home in the hospital. This positive attitude of staff towards their working environment has great effects on their work satisfaction and efficiency, which directly translates to a more positive experience for patients.

General Design ConsiderationsA major factor in Cancer Center Design is the amount of patient examination and treatment areas. The number of patients which are being treated and the type of environments for healing more often than not determine the space requirements. One of the next major design considerations would be the patient flow and how far the patients have to travel and how direct are the access points within the designTypical bubble diagram for laying out cancer centers http://healtharchitecture.wikifoundry.com/page/Cancer+Center+Design

MAJOR PARTS OF A CANCER CARE CENTERA. Out Patient's Department

The Out-Patient Department of a hospital mainly is about diagnosis and where people come for procedures that do not require admission to the hospital. It is one of the largest departments in the hospital and is visited by the greatest number of patients daily. It is therefore best accessed directly from the main hospital entrance. The outpatient department should be preferably on the ground level with a separate entrance and adequate parking facilities . It should be so designed to handle wheelchairs and stretchers . The patients first point of contact is the main OP reception desk from which they are directed to the sub-waiting area serving the suite of consulting rooms in which their clinic is being held. The building block of the department is the consulting/examination suites which can be a number of combined C/E rooms or some combination of consulting rooms and examination rooms. CONSULTING/EXAMINATION ROOM LAYOUT

SPATIAL NEEDS OF ASSISTED EXAMINATION It involves in the major service of a wide range of treatment ,diagnostic tests and minor surgeries , some of which required hospitalization earlier. Here is where many come for the first time when they suspect cancer. It is imperative for a person to put himself in a patients shoes when designing such an environment. The space must be large enough not to feel cramped, easy flow pattern and signage to avoid confusion for the patients. Waiting area should have plenty of circulation space. `Suggested Flow Charts for OPD Source: Time Saver Standards for Building TypeB.Inpatient's Department The In-patient wards must have restricted access to only patients, doctors and nurses. The admission on visitors should be restricted to different times. The wards should be spacious to prevent a feeling of claustrophobia. Their should be adequate entertainment facilities and privacy. At the same time all wards must be in sight of a nurses station to detect an emergency situation. The Nurses station forms the focus of the wards. Nursing unit relationship In-Patient Department Adjacencysource:Modern trends in planning and designing of hospitals In patient and Out Patient services

Ward typology

3. OT Complex

Generally speaking OT Complex have a central localization in the hospital. This department is mainly a part of the surgical Oncology Department. This area is highly sterile in nature. There must be no entry of germs and bacteria in this area. Usually this is achieved using a positive pressure HVAC system with Hepa-filters. This allows for air inside this space to be of a higher pressure that that of the inside. Thus ensuring that there is no intake of air from other parts of a hospital. And the rate of return air is lower than the throw of air ensuring the air only moves out of this area. OT Complex have to be placed close to intensive cares services, waking units and sterilization services. The OT Complex/Floor mainly consists of the Surgical Oncology Department, the Surgical Ward, Preparation Room, Operating Theatres, Scrub Rooms, Nurses Station, Anaesthesia Room, Dirty Corridor, clean Corridor etc. Suggested Flow Charts for OT Complex Source: Time Saver Standards for Building Types

Organization of a surgical unit: Operating room: 40-48 m2 Ante-operating room: 15-20 m2 Post-operating room: 15-20 m2 Wash room: 12-15 m2 Equipment room: 10-15 m2 Anaesthesia room :12-15 m2 Sterile goods room-10 m2

Typical OT Complex Floor Plan

A two-passage circulation: A separation between different working units is required to reduce germstransmission, A separation between circulation of non-sterilized and sterilized patients and implements is also required.Plan : Surgical wings showing two passage circulation

4 Intensive Care Area The task of intensive care area is to prevent life threatening disruption of vital body functions after the surgery or treatment such as disruption of breathing, metabolic disturbances, infections, sever pain etc. The services of intensive care include monitoring and treatment as well as care of the patient. Organization of intensive cares units: A airlock, A room for registration and administration, A secretarys office: nurses have to watch the arrival of patients, medicines. An operating room (for slight operations): 25-30 m2 A laboratory, A sterilization room: 20 m2 A room for non sterilized apparatus, A room for sterilized apparatus, A wash room. Cares units, Plan : intensive care area

A. 5 Chemotherapy Treatment Design The space should provide separate patient rooms and/or individual cubicles to provide privacy, while allowing for an open treatment area for patient interaction. Chemotherapy is considered a nontechnical area of treatment and is deemed safe for both patients and all others alike. The treatment area requires a close connection between itself and the pharmacy for preparations of the administered drugs. Typical Spaces for Chemotherapy Treatment: Open treatment bays...60 sqft Treatment Cubicles......60 80 sqft Treatment Groups........100 150 sqft Nurses' Station..............150+ sqft Patient Toilets................50 60 sqft Family Waiting Areas.....15 sqft per person Examination Rooms......120 sqft

6.Diagnostic department:

A. X Ray department:

The primary and most basic form of diagnostic is an X-Ray. This department has two basic methods of checking. One is a regular X-ray the other is a more advance form which is a CT Scan. A CT Scan is a simple procedure which requires only the additional machine room and the equipment room. Standard X ray room and admission rooms should be of 20-30m2 accessed by two changing cubicles. CT and admission room should have an of area of app. 35 m2 . This service requires a direct access from the emergencies for lying patients. It must be situated on the ground floor or at the first ground (because of weight of apparatus).

Typical X ray Ray Department

eg:X ray Ray Department St.Elisabeth Halls

B. MRI

Magnetic resonance imaging (MRI), or magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to visualize detailed internal structures. This machine has a strong magnetic field and hence requires that there be no long-term occupancy in the magnetic field of the machine.

Typical layout of an MRI Machine including precautions.Source:ACR Guidance Document for Safe MR Practices: 2007

C. Nuclear Medicine (Diagnostic) Nuclear medicine is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. In nuclear medicine procedures, radionuclide's are combined with other elements to form chemical compounds, or else combined with existing pharmaceutical compounds, to form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs or cellular receptors. This property of radiopharmaceuticals allows nuclear medicine the ability to image the extent of a disease process in the body, based on the cellular function and physiology, rather than relying on physical changes in the tissue anatomy. Gamma Camera A gamma camera, is a device used to image gamma radiation emitting radioisotopes, in the medical profession it is called scintigraphy. One of the applications of scintigraphy is nuclear medical imaging to view and analyse images of the human body or the distribution of medically injected, inhaled, or ingested radionuclide's emitting gamma rays. This room requires thick concrete walls along the path of the radiation.PET-CT Positron emission tomography - computed tomography (better known by its acronym PET-CT or PET/CT) is a medical imaging device which combines in a single gantry system both a Positron Emission Tomography (PET) and an x-ray Computed Tomography. The procedure involves the patient being injected by a radioactive isotope (FDG) prior to imaging. This entire department usually has concrete walls of specified thickness and lead lined windows (if at all any).

A typical lay out for nuclear medicine facility having both gamma camera and positron emission tomography-computed tomography (PET-CT) installations. Source:AERB Guidelines

D. Endoscopy

Endoscopy allows the doctor to look into the body through a thin, lighted tube called an endoscope. The exam is named for the organ involved (for example, colonoscopy to look inside the colon). During the exam, the doctor may collect tissue or cells for closer examination.

7. Clinical Laboratories- Pathology Department

This department carries out tests on patients and patient specimens; the test results are a crucial aid to diagnosis. Laboratory tests such as blood and urine tests give the doctor important information. If cancer is present, the lab work can show the effects of the disease on the body. In some cases, special tests are used to measure the amount of certain substances in the blood, urine, and other body fluids, or tumour tissue. The levels of these substances may become abnormal when certain kinds of cancer are present.Flow chart of a Pathology Laboratory Source: Timesaver Standards for Building TypesTypical Layout Of Pathology Lab

8. Treatment Department

Radiation therapy Radiation therapy incorporates an initial examination and consultation with the patient, treatment planning with the staff, and simulation treatment to confirm that the treatment will be successful. Radiation therapy is performed in a highly technical area with large equipment which is controlled by specialists. The treatment is usually distributed by large linear accelerators. The equipment used for radiation therapy is extensively large and requires a large enough space to allow the machine to rotate 360 degrees. This typically calls for nothing smaller than a ten foot ceiling height and in most cases it is taller than that. Since the treatment gives off radioactive waves in most cases, extensive shielding is required within the walls. While lead and steel can be considered highly effective shields to prevent the waves from entering surrounding areas, concrete is typically recommended because of its density and lower cost. In order to shield the surrounding spaces an 8 foot thick concrete wall is poured which calls for the radiation therapy treatment spaces to be located either on ground level or underground due to their shear size.Typical Spaces for Radiation Therapy Treatment: Therapy Vaults(high energy)......600 sqft Therapy Vaults(low energy).......500 sqft Control Areas..............................130 sqft Equipment...................................100 sqft Entry lobby...................................140 sqft Simulator.......................................300 sqft Treatment Planning.....................200 sqft Specialist Office.......................120 sqft Patient Toilets.................................60 sqft Sub Waiting Areas........................20 sqft per person Family Waiting Areas................18 sqft per person

a. Cobalt Therapy Cobalt therapy or cobalt-60 therapy is the medical use of gamma rays from cobalt-60 radioisotopes to treat conditions such as cancer. Layout includes restrictions on occupation in and around the units, Extra Thick Concrete Walls for Cobalt Unit.

Diagrammatic Representations of Cobalt Therapy unitb. Linear Accelerator Therapy (LINAC) Linacs have many applications: they generate X-rays and high energy electrons for medicinal purposes in radiation therapy, This technique is well established and is generally quick and reliable. The worry is that some high-dose treatments may be limited by the radiation toxicity capacity of healthy tissues which lay close to the target tumour volume. Here as well there are restrictions on occupations as well as the thickness of the wall is high. And precisely shaped to the beam of radiation when machine is in use.

c. Stereotactic radiation (Tomotherapy) Stereotactic radiation is a specialized type of external beam radiation therapy. It uses focused radiation beams targeting a well-defined tumour using extremely detailed imaging scans. Tomotherapy is a type of radiation therapy in which the radiation is delivered slice-by-slice This method of delivery differs from other forms of external beam radiation therapy in which the entire tumour volume is irradiated at one time.

Picture of a Tomotherapy Machine

d. Radioisotope therapy (RIT) Systemic radioisotope therapy is a form of targeted therapy. Targeting can be due to the chemical properties of the isotope such as radioiodine which is specifically absorbed by the thyroid gland a thousand fold better than other bodily organs. Targeting can also be achieved by attaching the radioisotope to another molecule or antibody to guide it to the target tissue. The radioisotopes are delivered through infusion (into the bloodstream)or ingestion.

e. Brachy- Therapy Brachytherapy also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment.Diagrammatic Representations of Brachytherapy unit

f. Bone Marrow Transplant(BMT) Unit In the case of a bone marrow transplant, the HSC are removed from a large bone of the donor, typically the pelvis, through a large needle that reaches the center of the bone. The technique is referred to as a bone marrow harvest and is performed under general anaesthesia. After several weeks of growth in the bone marrow, expansion of HSC and their progeny is sufficient to normalize the blood cell counts and reinitiate the immune system. The offspring of donorderived hematopoietic stem cells have been documented to populate many different organs of the recipient, including the heart, liver, and muscle, and these cells had been suggested to have the abilities of regenerating injured tissue in these organs. However, recent research has shown that such lineage infidelities does not occur as anormal phenomenon.

8. Rehabilitation departmentTo encourage an integrated approach to patient treatment, the rehabilitation department encompasses a number of therapies.The increasing recognition of occupational therapy as an integral part of the medical rehabilitation program has resulted in its becoming an increasingly important element of hospital planning . Physiotherapy: dealing with problems of mobility and function using natural approaches such as movement and manual therapy, supported by electrotherapy, cryotherapy and hydrotherapy. Occupational therapy: improving patients function and minimising handicaps through the holistic use of selected activities, environment and equipment adaptation so they can achieve independence in daily living and regain competence in work and leisure. Speech therapy: dealing with communication problems, either individually or in groups, if necessary by introducing alternative methods of communication; family members may be involved and family counselling plays an important part. Typical layout of an Physical Therapy Department Source: Time Saver Standards for Building TypesC H A P T E R I I : L I T E R A T U R E S T U D Y9.Mortuary Here the hospital takes the deceased person for temporary holding and then handover the body to the next of kin. It should be located in a separate building ,easily accessed and preferably away from general traffic routes used by public. It must have a separate entrance and exit route for the hearse vans and relatives . An area of 0.6-0.8m2 /bed is recommended and usually 4 body holding spaces are required for every 100beds. Corridors should be minimum 2400mm wide to allow easy passage of trolleys. The temperature of cold room is to be maintained between 5.50c-6.50c.

Typical layout of mortuary

10.Pharmacy In the hospital pharmacy, drugs are received, stored, dispensed to out-patients and issued to wards and other departments. It should be easily accessed to all areas of the hospital and should be close to lifts and pneumatic dispatch systems. minimum space requirement for the pharmacy units should be around 20sqm and it varies depending on the number of beds in the hospital. Typical layout of pharmacy11.Reception/information desks The reception area, should be visible from the main entrance. Receptionists need to oversee the waiting area and the main circulation routes. Allow 1.5 m counter length for each receptionist, and space in front of the counter for patients to stand without encroaching on circulation routes or waiting space. The height of the counter should be adapted to the needs of wheel chair patients. It should be adjacent to triage area.

12.Waiting areas These waiting areas should provide sufficient and comfortable space for waiting patients and relatives/escorts. The area should be easily observed from reception and triage areas. Waiting areas should be planned to accommodate more than the number of people expected during peak hours. visible from reception but sufficiently separated to provide some privacy for patients at the reception desk. Six seats should be allowed for each consulting room and treatment room, allowing 1.4 m2 for each. This can be reduced for larger premises, particularly when appointment systems are operated. Arrangements can be made to screen off part of large areas to provide space for other activities at times when it is not all required for waiting. Patients should not wait in corridors nor outside consulting or treatment room doors. Sub-waiting areas should usually be avoided.

Hospital waiting areas

13.Medical Record storage The Medical records department (MRD) encompasses the admission office (which maintains waiting lists, arranges admissions and appointments and may be separately sited near the main entrance), the library (which handles filing, storage and retrieval of health records, both current and archived) and the office (which communicates with health professionals, sorts and maintains the notes and index). These should be out of sight of patients and secure. General Patients records will be kept centrally near reception. Other records may be held at staff offices. The space required can be extensive and needs to be calculated for the selected storage system (lateral shelving, filing cabinets, carousels). The admission and enquiry office should be around 15-20sqm with waiting areas @0.5sqm/bed and the storage space should be 15-50sqm. The medical office should be @ 1sqm/bed, but would also depend upon the status of computerization of the hospital. Plan of a reception area

12.House keeping and waste management Housekeeping and waste management are most important among the support services which contributes to the greatly to the wellness of the hospital. The main objective of these services is to keep the environment clean with the ultimate goal of reducing hospital associated infections, thereby decreasing average length of stays of patients. It is necessary to provide sufficient spaces for housekeeping at the patients ward adjacent to the vertical transportation systems and separate storage spaces for bio medical wastes on every floor before being sent for treatment and final disposal. The waste water is recycled to use for landscaping. The bio-medical wastes are usually sorted and given to an out-sourced company to incinerate the non-recyclable products and adequately deal with the rest.

1. 2. 3. 4.

1.Housekeeping2.BMW collection containers3.Needle incenarator4.Hand wash station5.Microwave 5.

13. Laundry service Hospital laundry system is an integral part of the health care institution. Laundry services have an important function in the cleanliness and disinfection process of linen. The location should be convenient to the service staff units and close to the service elevator. Generally located in the basement. The average floor area requirement per bed varies from 0.10sqmm-0.45sqm with ceiling height of 4.5m.The door widths should be minimum 1500mm.

Typical laundry plan

14. Administration This is where the main administration of the hospital has their offices. There should be appropriate checks to ensure that not everyone enters this area. Some medical staff require offices for full-time use. Others, such as health visitors, district nurses and midwives, need to return to an office base once or twice a day. It must be secure from infiltration, however the waiting must be adequate to ensure comfort for visitors and not create a disturbance for the hospital personnel. Some clerical/administration is usually associated with the record storage.

SnoSpace Area in Square Meters

Administrative Service

Lobby

Waiting Area0.65/person

Information and Reception Area5.02/staff

Toilet1.67

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 9.29/vehicle

Supply Room 5.02/staff

Waste Holding Room 4.65

Dietary

Dietitian 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 1.40/person

Toilet 1.67

Cadaver Holding Room 7.43/bed

Qualitative factorsEntrances: Only one main entrance, The emergency department must have its own entrance and it is desirable to have it located adjacent to the outpatient department. the entrance should be well marked and illuminated. it should open into a spacious lobby and there should be a porch outside the lobby to protect the unloading of the patients from rain and sunlight .

Corridors: Access passages: 1.5m wide, Passages for lying patients transfer: 2.25m wide minimum, Ceilings in passages: 2.40m high minimum, Maximal distance between two windows in a passage way: 25m, Width of passage ways mustnt be reduced by any object or post, According to the regulations fire doors are required in passage ways.

Doors/windows: Doorways should have minimum 90cm width clear opening width to allow easy patients/visitors/staff and 115cm width clear opening for those on wheel chairs. A level space of at least 152cm wide should extend about 45cm on either side of the door way for facilitating opening/closing by a wheel chaired person. Coverings have to be resistant to the maintenance and disinfectant products. The same sound insulation as the one for walls is required: a leaf with two wallscan absorb noises up to 27 dB minimum. Height of doors: 2.1-2.2m, Height of over designed doors for cars: 2.5m, Height of doors for the passage of transport vehicles: 2.7-2.8m, Minimal height of doors for access to a hall for lying people: 3.5m. Each window/glazed door should have direct glazed area of not less than 15% of the floor area of the room.Lifts: Lifts transport people,medicines,laundry meals and hospital beds between floors .At least two lifts should be provided and should be sufficient to accommodate a bed and two accompanying people.One multipurpose lift should be provided for every 100 beds along with a minimum of two for smaller hospitals.Clear dimensions for lift car - 0.90mx1.20mClear dimensions for lift shaft - 1.25mx1.50m

Stairs/Ramps:Recomended height of risers is 0.15mhaving 30m treads for stairs case is to be provided.For ramps the gradient should be between 1:12 and 1:20 .Pedestian ramps must have handrails one at 0.9m and the other at 0.5m for ease of people in wheel chairs, the minimum width of ramps should be 1.6m to allow easy passage of patients/visitors including those on wheel chairs.There should be a linding planned at every 9m. Side elevation of ramp in mmFacilities for disabledA single wheel chair requires a floor area of 1120mmx915mm.For two wheelchairs crossing each other a minimum clear width of 1800mm. height reach limits max forward reach

Specific design of circulation ways for handicapped peopleThe maximum forward reach for wheel chairs sers without obstruction is 1200 mmfrom the floor and the minimum, forward reach is 400mm.Wheelchairs should be readily available at the entrance lobby of the ambulatory care facility. One wheelchair requires a space of 1m2.Floor surfaces should be stable and slip-resistant. There should be any projections ,drops, or unexpected variations in levels.

ramp with handrails for ease of access of handicapped

Circulation in a wheelchair requires a specific design of the circulation ways - Passages: 1.30m wide minimum, better if 2m wide,- Doors: 0.95m wide minimum, a magnetic closure is advised,- Switches, handles, windows closure. have to be within easy reach: 1-1.05m high,- Wide pushbuttons are required,- Access ways: 1.20-2m wide,

Toilet facilities:A toilet cubicle for a wheelchair user should have clear internal dimension of not less than 1500mmx1750mm and should be equipped with grab bars.It should have toilet roll dispenser mounted below the grab bars and at not more than 300mmfrom the front edge of the seat