NIASA Metro Heart Thesis

Niasa

The project aims at the extension of the hospital form a .200 bedded multi super speciality quaternary care to a 500 bedded hospital focused more on the international medical tourists and advanced experimental surgeries. The thesis provides a good exer- cise of design due to extension design, long linear site and presence of a large scale dense building like a hospital.

Metro Heart Multi-speciality Hospital, Faridabad

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CONTENTS NISAA SITE ANALYSIS LITERATURE ANALYSIS CASE STUDY EXTENSION DESIGN DEVELOPMENT AREA STATEMENT SUMMARY DESIGN DEVELOPMENT LITERATURE STUDY COST ANALYSIS ADVANCED OBJECTIVES - HVAC SYSTEM FLOOR PLANS AWARDS

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EXECUTIVE SUMMARY The hospital is an integral part of a social and medical organization, the function of which is to provide for the population health care, both curative, and whose out patient services reach out to the family and its home environment. The hospital is also a centre for the training of health workers and for biosocial research. It is like a living organism trying to adopt itself to an everchanging environment; hence the last word in the hospital of today, is the first word in the hospital of tomorrow.

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DEMOGRAPHICS + ABOUT THE CITY

Faridabad

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Faridabad is the largest city in the north Indian state of Haryana, in Faridabad district. The district shares its boundaries with the National Capital and Union Territory of Delhi to its north, Gurgaon district to the west and Uttar Pradesh to its east and south. Faridabad enjoys a prime location both geographically and politically. Faridabad is also a major industrial hub of Haryana 50% of the income tax collected in Haryana is from Faridabad and Gurgaon. Faridabad is famous for henna production from the agricultural sector, while tractors, motorcycles, switch gears, refrigerators, shoes and tyres constitute its primary industrial products.

Rural/ Urban Household Ratio

Male/ Female Literacy Ratio

Male/ Female Employment Ratio

Male/ Female Gender Ratio

+ TEMPERATURE It is clear from the data that sometimes the temperature in summers may go as high as 39 degrees Celsius and may drop as below as 8 degrees Celsius in winter. It is understood from recent data that the mean monthly maximum temperature varies from 39 degrees to 21 degrees Celsius while the mean monthly minimum temperature varies from 28 degrees to 8 degrees Celsius.

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CLIMATE ANALYSIS

Faridabad is the largest city in the north Indian state of Haryana, in Faridabad district and covers an area of 2151 sq. km.

Longitude: 77.32 E Latitude: 28.43 N Altitude: 198 m above sea level

WIND

SUNPATH

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METRO HEART SUPER SPECIALITY HOSPITAL + INTRODUCTION

Metro hospital provides the best in health industry. Its unique amalgamation of world class high technology makes treatment better and with ease. Set up in the year 2002 as heart institute, metro hospital is now a renowned multispeciality hospital. We have capacity of 500 beds, from which 50 is especially for intensive care unit. Known as one of the finest centres for diagnosis, the cost of treatments is also pocket friendly. We believe in excellence, our dedicated team understands this and provides care with full attention. Our vision is to provide all health care solutions under one roof.

With a vision to provide the highest level of healthcare to the common man at an affordable cost, a group of NRI physicians led by Padmabhushan Dr Purshotam Lal founded the Metro Group of Hospitals.

+ ABOUT THE PROJECT

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MISSION

VISION

“Engineering the flow of healthcare under one roof...Our Mission is to provide all health care solutions. We practice the culture of Care.”

“We aim at making World class health care easily accessible to you. Together we are working to improvise the quality of your Life.. Healthy Life at very reasonable amount.”

+ DEMANDS OF HEALTHCARE INDUSTRY Malnutrition According to a 2005 report, 42% of India’s children below the age of three were mal- nourished, which was greater than the statistics of sub-Saharan African region of 28%. Although India’s economy grew 50% from 2001–2006, its child-malnutrition rate only dropped 1%, lagging behind countries of similar growth rate.

High infant mortality rate Approximately 1.72 million children die each year before turning one.The under five mor- tality and infant mortality rates have been declining, from 202 and 190 deaths per thou- sand live births respectively in 1970 to 64 and 50 deaths per thousand live births in 2009. However, this decline is slowing. Reduced funding for immunization leaves only 43.5% of the young fully immunized.

Hindu and Muslim infant mortality difference puzzle In India, Hindus are, on average, richer and more educated than Muslims. But oddly, Hindus’ child mortality rate is much higher. All observable factors say Hindus should fare better, but they don’t. Economists refer to this as the Muslim mortality puzzle. The study found that the Muslims, regardless of income, were 20 percent more likely to use toilets than Hindus who used open defecation more often.

+ SCOPE To design a multi speciality hospital’s extension from a 200 bedded tertiary care to a 500 bedded quaternary care hospital, in two phases.

Metro Heart, Faridabad 500 Bedded Cardiac Multi-speciality Hospital

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SITE ANALYSIS

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1. Features a. Geometry Rectangular site of 380m x 85m (on average)

Major drainage structure present, however increment for hospital needs to be done.

b. Connectivity The Site has a metro station proposed, and is located between two major roads which run parallel to a highway.

g. Soil and Vegetation Minimal vegetation present at site.

c. Access All four sides are road, and gates are open on the road side. d. Topography Planar site with no undulations. e. Slope and Drainage

+ AREA REGULATIONS a. Height not restricted 28m is usually provided. b. Setback 9-9-9-12m c. Ground Coverage 35-40% d. FAR: No Restriction, on approval.

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f. Existing Structures

h. Seismic Analysis Zone IV i. Water Table 30-50m j. Water Supply River based municipal supply.

SINGLE ENTRY TO THE HOSPITAL

FRONT ROAD: SECTOR 16 ROAD

SITE OF PHASE 2 & 3

+ SWOT ANALYSIS

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AN APPROACH TO HOSPITAL PLANNING

“Separate all departments, yet keep them all close together, separate types of traffic, yet save steps for everybody. That is all there is to hospital planning”.

- EMERSON GOBLE

A hospital may be defined as a building in which patients are cared for, nursed and treated.

Architects are dealing with the two main aspects of hospital: The building normally structure which is permanent and difficult to change once constructed.

• The patient care system a continually and rapidly changing system due to development in science and technology.

• Therefore, architect has to create a building which satisfies medical and spatial requirements that during the period in which the design is made are only partially formed and which after completion of the building science and technology lead to change to the building, he must also study staffing pattern and thus strive for such a building method in such a layout that will make it possible for the building to be used and maintained by minimum of staff.

• Hospital is a very technical building with very specific set of requirements and a definite way of functioning. Circulation, servicing, and flexibility are the chief considerations in hospital planning.

+ THE TOP FIVE CHALLENGES FACING TODAY’S HOSPITALS Financial Challenges & Hospital Productivity

Patient Satisfaction

Hospital Security

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Patient Safety Regulatory Standards & Energy Mandates

ROYAL CHILDREN’S HOSPITAL – MELBOURNE

MEDANTA HOSPITAL, GURGAON

+ WHY EXPAND/ UPGRADE? When the advances in technology happen -MRI & Robotic Ots -Advanced Invasive surgeries -Advanced Ventilation systems

When new hardships are faced -Cancers -Ebola like viruses

+ THINGS TO CONSIDER WHILE HOPSITAL PLANNING The architecture of hospital must respond to both the emotional content of hope and despair and to he functional requirements of treatment and technology.

Hospital is a very technical building with a specific set of requirements and a definite way of functioning.

CIRCULATION GROWTH AND CHANGE ENVIRONMENT COLORS DOORS AND WINDOWS NOISE

LIGHTING VENTILATION ORIENTATION FIRE SAFETY AUXILLIARY ELECTRICAL SYSTEM SIGNAGE AND GRAPHICS

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CASE STUDY

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METRO HEART ( THESIS SITE )

Max Hospital, Saket

Fortis Hospital, Gurgaon

BLK Hospital, Delhi

Narayana Heart, Banglore [Busi.Model]

Medanta Medicity, Gurgaon [Busi.Model]

Architect

Kothari Architects, Delhi

Richard Woods, Hong Kong

Rajinder Kumar Associates, Delhi

Constructure +Kothari Associates, Delhi

SNCS, Banglore

ARCOP

Beds

(200+200+100) 500

490

450 (1000)

700

3000 (1400Heart)

1600

Site Area

6.4 Acres

10.7 Acres

5.5 Acres

26 Acres

43 Acres

Built Up Area

2.5+(1+4)= 7.5 Acres P1 13600 sqm

49200 sqm

65450 sqm

53300 sqm

92,900 sqm

2,00,000 sqm

Ground Cov.

P1 0.85 Acres [34%]

1.53 Acres [24%]

2.52 Acres [23.5%]

1.45 Acres [26.36%]

7.02 [27%]

12.4 Acres [28%]

Floors

B+G+4

2B+G+S+5

B+G+4

B+G+S+7

B+G+7

3B+G+10

FAR

P1 1.32

1.9

1.5

2.4

N.A (0.86)

N.A (1.14)

Super Specialities

IVF, Gynae, Cardiac, Neuro, Oncology, Neonatal

Paediatric, Pain Management, Cardiac, Neuro, Trauma

Cardiac, Organ Transplant, EmergencyTrauma

Cardiac, Bone Marrow, Gastro, Renal, Child Heart, Neuro

Cardiac, Neuro, GI, General Surgery, Dental, Trauma

Cardiovascular, Cardio-thoracic, Minimally Invasive

Accreditions

NABH, NABL

NABH, NABL

JCI, NABH, NABL

NABH, NABL

JCI, NABH, NABL

JCI, NABH, NABL, ISQua

Site

Rectangular

Polygonal

Polygonal

Square

Rectangle

Square

Built Shape

Linear

Square

T Shaped

Semicircular + Square

Rectangle

T Shaped

Owner

Dr. Purushottam Lal

B. K. Modi

Devi Shetty

Dr. Naresh Trehan

Malvinder Mohan Radiant Life Care Singh Pvt Ltd

+ FORTIS HOSPITAL, GURGAON Presidential Suite 1 Suite 4 Deluxe Room 8 Board Room Office Cabin 4 Office Rooms 6

CSSD

Double Room 22 = 44 Beds Single Beds 23

OT - Second Floor

OT Complex 10 ICU(1-7) 85 Beds Recovery 9 Beds Private Wards 6 CathLab 4 Pbeds ENDO 3 Pbeds NICU 14 Beds Surgical Wards 9 Beds Blood Bank and Labs General Ward 40 Beds ICU Recliners 77 Cubicle 40 Eye/Dental Chemo/Dialysis 19 PBeds

Basement Plan

Engineering Services well a ccessed and arranges into service yards OT Segregation based on severity OT Pre screening helps crowd management Laundry and staff dining on Ground floor, allowing for expansion OT Pre screening helps crowd management Laundry and staff dining on Ground floor Excellent Visual connectivity Sleeping area for friends visitors ICUs p laced in order of severity to OT and along the North Modern OT with bagging mechanism render Dirty corridor obsolete View to all rooms

Cardiac/Gynae/Obs OPD Food Court SPA Oncology OPD

Emergency OPD Labs + Diagnostics Staff Dining + Laundry SwitchBoard + Oxygen Yard Parking

Pump Room Kitchen + Stores Pharmacy + Drugstore Oncology OPD Service Yard + UPS Parking Basement: 234

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+ MAX SUPER SPECIALITY HOSPITAL, SAKET Double Ward 9 = 18 Beds Single Ward 26 Beds 4 Bed W ICU 8 Beds Nurse Room 8 Double Bed Room 7 = 14 Beds CSSD

OT - First Floor

Double Ward 9 = 18 Beds Single Ward 16 Beds ICU 10 Beds 4 Bed W ICU 8 Beds Single Bed Ward 9 Double Bed Room 6 = 12 Beds 4 Bed Ward 1 OT AHU

Service Floor Plan

(+) CSSD with duct right below OT (+) Provision for expansion (+) Oncology and Physiotherapy Placed (-) High Occupancy General Ward on south facade (-) Indoor atrium turned into claustrophobic waitings (+) OPD Segregation (-) Waiting on same floor causes anxiety.

(-) Large distance between OT and ICU (+) Separate OT allow for better trained staff (+) AHU and DU on service floor (+) Option to expand on service floor (+) AHU and DU on service floor (-) Linear wards are tougher to supervi (+) AHU and DU on service floor (+) Option to expand on service floor (+) AHU and DU on service floor

Daycare 6 Beds OT Complex 3 Observation 8 Beds Coronary Care 11 Beds Step Down ICU 8 Beds Cardiac Surgical ICU OT GEN + 1 Ortho+ 1 Neuro) Stroke Unit 8 Beds Surgical ICU 10 Beds Ortho ICU 3 Beds Endoscopy Dexa - Radiology

Cardiac OPD General OPD Cardiac Ward 20 Beds Emergency Neuro/Ortho OPD

Admin + Dining + Kitchen Parking Basement: 54+55 CSSD Changing Rooms GAS Manifold Café Physiotherapy Pump Room AC Plant Bachy-therapy Room

Pump Room Parking Basement: 54+55

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OT AHU OT Service Area Kitchen-Dining Waiting and Terrace

+ BLK SUPER SPECIALITY HOSPITAL RAJENDRA PLACE, DELHI Single Room 30 Beds Double Room 13 Beds Three Bedded 9 Beds Conference Room 278 Single Room 30 Beds Double Room 13 Beds Three Bedded 9 Beds Conference Room 278

Single Room 30 Beds Double Room 13 Beds Three Bedded 9 Beds Conference Room 278

SECOND FLOOR

Single Room 30 Beds Double Room 13 Beds Three Bedded 9 Beds

Testing Labs Dialysis 10 Beds OPD Seminar Rooms

OT Services Staff Dining EPBAX-AHU

Basement Plan

(+) Services in cul de sacs with ducts (+) Blood Bank close to emergency (-) Kitchen on ground (+) Blood Labs close to emergency (+) Office located visual entry (+) OT supported by services in service floor (+) Office located visual entry (+) Space for expansion of services (+) Dirty corridor empties into service floor (+) Proximity if ICU (+) ICU planning allow better NS arrangement and noise control

Testing Labs Dialysis 10 Beds OPD Seminar Rooms

Emergency Café OPD Diagnostics/Radiology Oncology Therapy Pump Room

Parking 80 Laundry HVAC Plant Gas Manifold Oncology Therapy Pump Room

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+ PHASE 1 (ON SITE): METRO HEART, FARIDABAD Fourth Floor General Ward 112 Beds Single Room 6 Beds

Third Floor General Ward 112 Beds Single Room 6 Beds

Second Floor Single Room 18 Beds MICU 8 Beds Birthing Centre 2 Beds OT Wait

CSSD

OT

FIRST FLOOR

First Floor CSSD Daycare 6 Beds OT Complex 4 CTVS 14 Beds Step Down CTVS 14 Beds SICU 14 Beds CCU 14 Beds Step Down CCU 14 Beds Endoscopy Cath Lab

Basement Plan (-) Same entry for all vehicles makes a bottleneck (-) Rickshaw in-front prevent easy vehicular access (-) Ramp restricts entry to Emergency (-) Admin Next to noisy engineering services (-) Blood bank in very awkward corner (-) Services not along the walls / ducts (-) Confusing Circulation (-) Basement used as a storage yard and is a fire risk (+) Garbage just along the service core and with adjunct road access (-) Dialysis /Kitchen / Master Health Checkup using important floor space (-) Blood bank in very awkward corner (-) Eye/Derma needs to be relocated in front (-) OPD away from reception and not segregated (long the service core and with adjunct road access (+) VIP Entry (+) No Dirty corridor, Dirty Boxes used. (+) No OT Wait to remove disturbances (+) Complete Floor maintained at a sterile environment (-) MICU on west side (-) Terrace turned into Ward Space (-) Translucent Light-wells used cut off view (+) Nursing Station location not most adequate

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Ground Floor Kitchen - CafĂŠ Master Health Checkup OPD Emergency Diagnostics Pharmacy - Shop Admin Main office Basement Floor HVAC-Boiler-Pump ADMIN-Pharmacy-Stores Labs Garbage Mortuary Physiotherapy

EXTENSION DESIGN CONSIDERATIONS

Expansion considerations and limitations

Expansion Limitations

Direction of Expansion Hospital expansion is recommended on West or the South Side. Our site allows for south Extension.

37m 28m

Phasing of Central Lobby / Services Services/Lobby become too distant from the rest of the hospital

Fragmentation of Expansion The hospital becomes three independent hospitals. Eg. MAX Saket

Lobby

Block C

OT Complex OPD distance Distance from service from basement Reception

OT Complex Reception / OPD

Block A Block B

Service

Expansion Proposal 1

Expansion Proposal 2

Ground Coverage 44%

Ground Coverage 48%

OT Complex

OT Complex

OT Complex

OT Complex

OPD

Reception / OPD

OPD

Reception / OPD

Basement Parking + Admin

Service

Basement Parking + Admin

Basement

Service

Basement

Expansion Proposal 3

Expansion Proposal 3

Ground Coverage 34%

Ground Coverage 34% FAR 1.9

Basement Parking + Admin Basement

OT Complex

OT Complex

OPD

Reception / OPD Service

Ward

Ward

Kitch.

Ward

Ward

Ward

ICU

ICU

Ward

ICU

ICU

ICU

OT Complex

OT Complex

Luxury

OPD

Reception / OPD

Basement Parking + Admin

Ward

Service

Basement

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AREA STATEMENT SUMMARY

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DESIGN DEVELOPMENT

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LITERATURE STUDY

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Services were integrated from the first phase buildings and interinking via sky -bridges and internal courtyards were created. Careful planning to create spaces so that none of the wards are dinggy and theft/accident prone. The hospital is kept well lit and has ample for visitor spillovers and it creates like a fabric of skin between the function and social. The hospital housed in a intentionally simple and harmonious facade.

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DESIGN STRATEGIES + ARCHITECT’S POINT OF VIEW Hospitals are the second most energy-intensive buildings after restaurants, and globally, healthcare costs are on the rise.

Violence, infant abductions, patient wanderings, and theft of drugs and hospital assets are major concerns.

1 in 25 men patient admitted to hospital in India dies of Hospital Acquired Infection.

All these factors are something which a proper hospital expansion can handle well. Thus its vital that architects not only play the role of managing modular designs but instead take a plunge and interact with the design itself.

Proper planning of how new inventions and problems can play out is very crucial in the design of multi super speciality expensive hospitals.

+ STRATEGIES A service chain has been made as backbone at the back of hospital.

The lobbies have been divided and kept at the centre of the hospital.

OT cluster can be created and joined to form a phase 4.

Parking can be accommodated on ground and basement.

A new block allows easy integration of new technology but at same time does not lead to disintegration of specialities.

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COST ANALSYSIS

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25

26

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Finally we get the cost of INR 3000 per square feet.

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ADVANCE OBJECTIVES- HVAC SYSTEMS + A central HVAC system has been designed to provide year- round thermal environmental control

for the building. Summer air conditioning shall be provided by a central chilled water system.

Winter heating shall be provided using electric hot water generator.

The central air conditioning shall consist of centrifugal water chilling units, chilled/hot water pumps, condensing water pumps, FRP induced drape cooling towers, electric hot water generators, air handling units, chilled/hot and con- densing water piping, air distribution system, insulation, electrical panels, wiring, con- trol wiring and earthing.

The chilling units housed in the air conditioning plant room. Chilled water from chilling units shall be pumped into insulated chilled water pipes installed in the ceiling spaces in the plant room and vertical risers in the shafts. Chilled water system shall be designed for reverse return flow of chilled water for self-balancing of water flows. Circulating the hot water through the same system shall provide winter heating. The piping of the system shall remain full of water round the year to prevent corrosion of the piping.

Air handling units shall be provided for individual spaces. Acoustically lined supply air ducts shall be installed in the ceiling spaces. Conditioned air shall be directly dis- charged through supply air grill/diffusers. Return air shall be taken back to the air handling unit room through the ceiling spaces.

Condensing units shall be placed in the A.H.U. with sufficient fresh/exhaust air grills. Fan coil units shall be provided within the rooms to be air conditioned. Conditioned air shall be directly discharged to the space and return air shall be taken back directly to the evaporator units.

Air-cooled package units shall be provided for air conditioning computer rooms to achieve required contention for effective cooling for computers.

Plant room, generator room and stores shall be provided with central mechanical ventilation system. The system shall consist of centrifugal fan, fresh air intake grills with filters, air distribution system and grills, motor starters, wiring, control wiring and Metro Heart Super-speciality Hospital, Faridabad.

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A. Each chilling unit shall be monitored to work as close to full load as possible. No chilling unit shall be allowed to run at less than 30% capacity.

B. Cooling tower fan motors shall be to speed fan motor, so that during lower am- bient wet bulb temperature it shall automatically operate at lower speed, thus conserving power.

C Close monitoring and measurement of chilled water and condenser water tem- perature to permit minimum swing from set point.

D. Remote sensing of temperature and humidity and remote controlling of AHU operation.

E. Automatically deciding to switch of all chillers during off-season and run only AHU’s at maximum open position for free cooling.

F. Logging of all faults and data.

G. Pre-warning messages and alarms facilitating cost effective, preventive main- tenance of various systems. The messages shall be monitoring of high/low tem- peratrues and pressures.

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FLOOR PLANS

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BASEMENT 2

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GROUND FLOOR

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+

FIRST FLOOR

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SECOND FLOOR

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SERIVCE FLOOR

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FORTH FLOOR

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+

FIFTH FLOOR

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SIXTH FLOOR

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SEVENTH FLOOR

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SOUTH ELEVATION

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NORTH ELEVATION

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+

3D VIEW

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3D VIEW

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AWARDS

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37

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