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T ERMINAL
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A SEMESTER OF RESEARCH THROUGH THESIS WORK
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CONTENT
The Med Lab 010 Research Obesity Population Issue for Bariatric Care Bariatric Equipment Case Studies Future Hospital mode
042 Early Exercise 050 Precedents 056 Hypothesis Program mapping Mechanical Interface Context Massing Study
078 Design Mechanical Interface Design Resolution
MELBOURNE UNIVERSITY MELBOURNE SCHOOL OF DESIGN FACULTY STUDIO LEADER Dr Rebecca McLaughlan Research Fellow
MELBOURNE SCHOOL OF DESIGN Julie Willies, Dean Andrew Hutson, Deputy Dean Alan Pert, Director, Melbourne School of Design Donald Bates, Chair of Architectural Design Marcus White,Director of the Master of Urban Design
REVIEWERS Codey Lyon,Principle in Lyons Sarah Blascke,PhD Candidate at Peter MacCallum Cancer Centre Alan Pert, Director, Melbourne School of Design Ruby Lipson-Smith,PhD Candidate at Peter MacCallum Cancer Centre STUDENTS Yanjie Zhan MUD’17 Printed by MSD
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The Med Lab
The world is growing bigger; the obesity population is growing at a rapid rate. Over the past few years, the obesity problem has caused national health issue in US, UK and Australia. The obesity is becoming the direct cause of the chronic disease, Diabetes, Heart Attack and
cancer, etc. Thus, the hospital has to face more and more bariatric patients across the entire department. In the hospital, Patients presenting to hospital frequently need assistance to move between departments, to and from equipment, change posture for tests or procedures and everyday care or hygiene activities.
With obese and bariatric patients this poses specific challenges. At present staff members experience with bariatric patients are identified within their own departments and work roles. The commonality of issues and needs related to patient handling and transfers are not readily identified across the hospital. Moreover, the bariatric patients often experience the discrimination and stigmatization during the stay. Along all the disadvantage, the patients becomes bed bound and have negative emotions in the hospital. The current strategy has not challenge the traditional hospital practice. The common ones are building up the ceiling systems for the mechanical tools, making the room larger or customized the required equipments for the bariatric patients. However, the dignity and comfort of the bariatric patients has always been ignored. This project provides a critique of this contemporary approach highlighting that, within a context of “patient-centred care�, the experience of bariatric patients has not been seriously addressed. XXL Terminal provides the critiques of the contemporary hospital practice, to be more process-like, to be designed for robotics, machines and mechanics, to be focusing on efficiency. The patients’ perspective has been lost all along the way. Specifically in the field of bariatric patients, this design approach has made the experience of the bariatric patients much worse and without dignity. Thus, the project will push the idea of efficiency to the extreme to be provocative about what the true issue
of hospital system is.
Yanjie Zhan Master of Architecture
RESEARCH
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The research we investigate are the growth of obesity population, affecting the special service from the hospital. And several issues on bariatric inpatients’ physical and mental care are severe because of its size and difficulty of care. Also, the issue starts to question the future mode of hospital.
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Obesity Population
Obesity Population growth has been a pajor issue that we could not avoid. Excess weight is a major risk factor for cardiovascular disease, type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk of developing these
conditions. In addition, being overweight can hamper the ability to control or manage chronic conditions.Also, we look at the diversity of the population starts to drive the importance of the public space. Public space is a democratic space that provides the space for interacting and communicating.
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22,700
weight loss surgery separations were recorded in 2014-2015, an increase from 9,300 separations in 2005-2006
28%
of Australian adults were obese in 20142015, an increase 19% in 1995
2 in 3
Australian adults were overweight or obese in 2014-2015
7%
of the burden of disease was attributable to overweight and obesity in 2011
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% 40
30
20
10
0
18-24
25-34
35-44
45-54
55-64
65-74
75 and over
2012 2007 1995
Proportion who were obese over time The obesity rate in Australia is distrubuted in different age groups. And over the years, the percentage of the obesity population has grown significantly. At the peak rate, nearly 40% of the people from age of 55-64 are obesity and it is still growing.
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%
38.2%
40
34.9%
30
20
10
0
18-24
25-34
35-44
45-54
55-64
65-74
75 and over
Total Female Male
Proportion who were obese by age and gender The obesity problem also across different genders. The male obesity rate is generally higher than female obesity rate along all ages. However, the overall highest rate of obesity generally happen around age 55-75.
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Issues for Bariatric Care
From the early research, we have discovered the growing population of the obesity. And it means the hospital is facing more bariatric patients in the future. So,
this chapter tends to look at the contemporary practice on Bariatric Care in physical and psychological aspects.
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“People who are more obese do sometimes feel stigma from providers and may get less care,” study lead author Dr. John Harris, , an assistant professor with the University of Pittsburgh School of Medicine
“I took care of a patient once who was morbidly obese and had trouble getting out of the house, Despite our best efforts, she became homebound, skipping medical appointments and ignoring what were probably early signs of colon cancer, which eventually took her life. I can’t say that obesity caused her death, but it was definitely a contributing factor to her choices not to seek health care” Casarett from Duke University
“Hospice at home often relies on friends and families to help with care needs throughout the day, which is only made more challenging when it requires more than one or sometimes more than two people,” Dr. Deepak Gupta, a clinical assistant professor of anesthesiology at Wayne State University in Detroit
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Stigmatization & Discrimination Survey of severely obese individuals found that nearly 80% reported disrespectful treatment from the medical community. Camden, 2006
Discrimination comes not only in the form of negative attitudes, remarks, and behaviors by caregivers and staff but also failing to acknowledge the physical needs for accessibility and safety to prevent patients from injuries. Mobility is a basic human need that, when not met, leads to a cascade of physical problems. Barr & Cunneen, 2001
Compared to non-obese individuals, a higher percentage of injury-related hospitalization was because of overexertion and falls. High number of musculoskeletal injuries among obese individuals are most likely caused by decreased mobility, strength, and body mass. Matter et al, 2007
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Workplace Injuries
Repositioning in bed 27%
Lifting 20%
Pushing Bed 5% Bed to toilet 8%
Lateral Transfers 14%
Assisting into or out of bed 13%
Percent of Injuries Occuring During Each Task There are several more questionable applicability to patient care: 1 ) Reaching and lifting loads far from the body 2 ) Lifting heavy loads 3 ) Twisting while lifting 4 ) unexpected change in load demand during the lift 5 ) Reaching low or high to begin a lift 6 ) moving a load a significant distance. Overall, all transfer tasks produce excessive compressive forces on spine.
Nurses consistently are ranked high among occupations with back pain and injuries. Humphreys, 2007
89%
of back injury claims files by hospitals are related to patient handling.
225%
workers’ compensation back injuries cost, more than non-work-related back injuries. 19
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Synthesis of Manual handling risks in the bariatric patient journey
Patient Factors
• People are getting bigger • Patient weight, height, BMI • Co-morbidities • Pain, panic, reduced weight-bearing • “When patients get to hospital they seem to lose their legs” • Reduced mobility due to surgery or illness • Patient comfort in equipment and dignity • Patient feels they are a burden • Patient needs to feel safe during moving and handling • Patient asks staff to lift or help move • Lack of privacy for assessments in maternity • Positioning for delivery • Increased risk of complications in delivery Equipment & Furniture
• Electric beds not always allocated • Manual beds do not function when used with bariatric patients; need more electric beds • Gzundas not used for all bariatric patients movements • Slidesheets not used with PAT slide • Hovermat not used in X-ray, ED • Theatres do not have a Hovermat • SWL not clearly labelled on all bariatric equipment. • Maternity & ED do not have bariatric wheelchairs • Equipment to far away to access easily
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Communication
• No pre-warning of bariatric patient arrival via Ambulance to Emergency • Staff on Wards unclear on patient mobility • No bariatric patient alerts in theatre • No advance notification to other departments of patient mobility status • No/little patient mobility information for Wardsperson, radiology or theatres • Students did not have patient mobility information • Staff unclear / do not check SWL of beds, commodes, shower chairs
Organisational and Staff Issues
• Bariatric Patient Management Plan not implemented in Departments • Staff unsure about safest patient handling methods • Lack of staff education on patient transfers • Staff unsure about SWL of equipment • No consequences provided for unsafe procedures • Bariatric patient incidents are not logged on IIMS • A culture of nursing staff standing back and relying on Wardspersons to do a large amount of patient handling tasks • No extra staff to assist with patient care
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Building Space Design
• Old building, small rooms • Clutter in rooms, no storage • No bariatric patient room • Theatre on separate floor to Maternity for caesareans • Delivery is on the floor above maternity • Awkward to manoeuvre equipment in spaces • Gzunda does not fit in lift with bariatric bed • Gzunda needs to be unlatched outside room and patient in bed manually placed in room – lack of space • Bed to bed patient transfer can only occur, at T intersection of Ward corridor • Only certain theatres can accommodate bariatric patient for surgery – depending on type of surgery; & if table tilt or X-ray required • Bedside table location to bed should consider patient mobility needs
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Bariatric Equipments
In terms of the physical aspects of the bariatric care, the mechanical equipments are essential for these overweight population. The types and functions of these equipments
varies depending on different needs of the patients and also different procedures’ needs for the hospital.
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Hill Rom Excel Bariatric Bed
Hill Rom Excel Bariatric Bed
107 cm (W) x 224 cm (L)
Stryker Big Wheel
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Hill Rom GPS
elheel Bariatric Bed
edy
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Hill Rom GPS
Mechanized Zoom StrykerStryker Bari 10A Bariatric Bed
Sabina II Sit – Stand lift
Stretcher Hill Rom GPS
Sling for Sabina Sit-Stand lift
Relining lift chair Stryker Mechanized Zoom
BartonChair/ Stretcher
Bariatric Lift Chair
cannot find an available Bariatric bed, please check with Managers to locate the ds and determine the greatest need for the beds. bed is available during regular hours, please contact Errol or Trevor in purchasing. O btaining additional equipment are limited. During the regular hours, purchasing can nt or borrow from another site but these options are not available outside of regular eekends or after hours, please try to manage with the available equipment above to or the patient until a more suitable bed can be found. Please remember that all beds a lbs/ 227kg and all Emerg Stretchers are rated for 700lbs/ 318kg. If no solution has bee e leave a message for Errol at 3330 or Trevor at 3243.
Steady Aid Bariatric Sit Stand Lift Sling for Stead Aid Lift Ergolift 600 Ergolift Sabina IIStand Sit – Stand lift Sling for Sabina lift lift nChair/ Stretcher Bariatric Lift Chair lift Sling forSit-Stand stead aid Slings for Ergolift or Ceiling Lifts in ICU or 5N or Unit 2
ind an available Bariatric bed, please check with Managers to locate the termine the greatest need for the beds. ailable during regular hours, please contact Errol or Trevor in purchasing. Our dditional equipment are limited. During the regular hours, purchasing can ow from another site but these options are not available outside of regular or after hours, please try to manage with the available equipment above to ent until a more suitable bed can be found. Please remember that all beds are g and all Emerg Stretchers are rated for 700lbs/ 318kg. If no solution has been message for Errol at 3330 or Trevor at 3243. Sling for lift from floor
Ergolift
Regular Ergolift sling (BHM)
Ergo lift
Regular ergolift sling Ergolift 600
Slings for Ergolift or Ceiling Lifts in ICU or 5N or Unit 2
Bariatric Sit Stand Lift
Sling for Stead Aid Lift
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Repostition
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T should be consulted
– Some bariatric walking aids available on each unit. Consult lab
b/ 227kg
U2 Bariatric Storage Room 235 b/ 227kg U2 Bariatric Storage Room 235 b/ 182kg U2 Bariatric Storage oom 514 Ceiling Lift Room 235 CeilingU2 lift Bariatric Storage b/ 318kg Room 235 area.
Evolution Walker Walker
Em Hover mat
Gzunda
d sheets, XXL Mesh Pants and Abdominal Binders are available b e Managers/Facility Manager from27central supply.
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Case Studies
After learning the physical and psychological obstacles for the bariatric patients, these fragments of the aspects affects every moments of the experience for
bariatric patients. However, in order to fully understand the whole experience, we need to map out the patients’ path through the hospitals to get a overall sense of their 28
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Bariatric patient journey modeling
Pathway 1 (Patient Code P1): Surgical short stay planned admission Key Environments/Activities: Ward - Theatre – Operating room – Recovery - Ward – Bathroom Patient:
Female 22 years, 182cm 173kgs (380.6lbs) BMI=51
Mobility:
Usually independent
Condition:
Gallstone pancreatitis (surgery within 30 days)
Co-morbidities:
Diabetes mellitus.
Length of stay:
1.5 days
Pathway 2 (Patient Code P2): Orthopaedic Planned Admission Key Environments/Activities: Ward - Theatre -Operating room- Recovery- Ward X-Ray - Bathroom - Physiotherapy Patient:
Female 56 years, 155cm (5’1”) 100kgs (220 lbs) BMI=42
Condition:
Right knee replacement
Co-morbidities:
Diabetes; R shoulder rotator cuff injury
Length of stay:
3 days
Pathway 3 (Patient Code P3): Emergency Unplanned Admission Key Environments/Activities: Ambulance to Emergency – X-ray – Emergency – Medical Ward – bathroom - X-ray – Surgical Ward - Theatre – Operating Room - Recovery – Surgical Ward – discharge. Patient:
Male; 56 years, 185cm (6’1”) 165kgs (363 lbs) BMI= 49
Mobility:
Independent with walking stick; tolerance around Shopping Centre
Condition:
Fall at home blacked out; multiple bruising and lacerations and discolouration to lower legs/feet; Knee haematoma;
Co-morbidities:
Diabetes; Epilepsy; Hypertension; High cholesterol; Depression; Sleep apnoea; Deep crack L foot; Laminectomy; chronic pain; cellulitis in leg areas
Length of stay:
5 days
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Pathway 1 (Patient Code P1): Surgical short stay planned admission Key Environments/Activities: Ward - Theatre – Operating room – Recovery - Ward – Bathroom
Day 1 Space
Ward
Theatre
Surgical team RN
ORA1
ORA2
Nurse
Staff
Positioned the equipment
Process
Equipment
Commence admission
Pt Transport to theatre
Pt move to OR table
Electric Bed
Gzunda
Hover Mat
RN: Registered Nurse Pt: Patient ORA: Operation Room Assistance
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Conduct surgery
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Day 2 Recovery
Ward
Surgical team ORA2
Pt move from OR table to bed
Hover Mat
Pt transfer in bed to recovery
ORA1
Pt transfer to ward
Student Nurse
Student Nurse
Lying to sitting to standing-walk patient to bathroom
Lying to sitting to standing-walk patient to bathroom
Gzunda
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Pathway 2 (Patient Code P2): Orthopaedic Planned Admission Key Environments/Activities: Ward - Theatre -Operating room- Recovery- Ward X-Ray - Bathroom - Physiotherapy
Day 1 Space
Day 2
Ward
Theatre
Surgical team RN
ORA1
ORA2
Nurse
Staff
Positioned the equipment
Process
Equipment
Commence admission
Pt Transport to theatre
Pt move to OR table
Electric Bed
Gzunda
Hover Mat
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Conduct surgery
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Day 3 Recovery
Ward
X-ray Room
ORA2
Surgical team ORA2
Pt move from OR table to bed
Easymove Slideboard
Pt transfer in bed to recovery
X-ray Wardsperson
ORA1
Pt transfer in bed from ward to X-ray
Pt transfer to ward
Gzunda
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Radiologist
Lifted Pt ankle, pt abducted leg; board positioned under knee to do conduct X-ray
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Pathway 3 (Patient Code P3): Emergency Unplanned Admission Key Environments/Activities: Ambulance to Emergency – X-ray – Emergency – Medical Ward – bathroom - X-ray – Surgical Ward - Theatre – Operating Room - Recovery – Surgical Ward – discharge.
Day 1 Space
ED
AO
Radiology
RN
ED
Radiographer X-ray X-ray Wardsperson Wardsperson
RN
Ward
Staff Pt moves to table
Stretcher to electric bed transfer
Process
Arrive by Ambulance
Equipment
Electric Trolley Bed
transfer to acute bay
Pt transfer in bed to X-ray
CT Scan Head
Pt transfer back to bed and to ED
Pt ad to w
ED w ch
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Day 2 Ward
Day 3 Radiology
dsperson
Wardsperson
Wardsperson
dmitted ward
Patient needs to use toilet; transferred with commode chair & back to room to bedside chair
Patient transferred in bariatric bed to x-ray via lift
wheelhair
Bariatric Commode Chair
Ward
Radiographer Wardsperson
Patient stayed in bed for knee X-ray
Patient transferred back to ward in bariatric bed
Surgical Ward
Wardsperson
Patient transferred to surgical ward pending surgery for knee drain
ED wheelchair
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Day 3 Space
Surgical Ward
Theatre
Wardsperson
ORA1
ORA1
ORA1
Surgical team
Surgical team
OR
Staff
Process
Equipment
ORA transferred patient from manual bed to electric bed
Conduct Surgery ORA transferred patient in bed with Gzunda to theatre
Electric Bed
Bed to operating table transfer
Operating table
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Transfer from operating table to bed
Easymove roller slideboard with built- in slide sheet
P transfe bed reco
RA2
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Day 4 Recovery
ORA1
Pt transferred in Pt bed from erred in recovery to d to ward overy
Gzunda
Day 5
Ward
RN
Patient walks to shower in next room accompanied by nurse
Discharge
Wardsperson
Wardsperson
Reposition in bed overnight
Electric bed mechanics for repositioning
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Wheelchair to taxi
Future Hospital Mode
Step aside of the bariatric care, in order to understand a broader image of the healthcare, we need to understand what the future hospital trends lies. Although there
are already lots of problems for the bariatric patients, how does the future hospital mode affect the bariatric care? Better or Worse?
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Hospital Dilemma
“I like greenery, rolling hills and proverbial trees.” “Far better to sit and be able to watch girls walk by on a busy city street.”
Future Hospital
Airport
Hospital
Process People
Process People
Complex Procedure
Complex Procedure
Airline Companies
Surgeons
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Hierarchical System
Decentralized System
- Opposite to specialized and zoning of the contemporary hospital, mix-use (medically) hospitals insert into urban spaces and disperse geographically. - Small clinics and hospice evenly distributed among the city. The information and knowledge is also distributed and shared as one whole unity. - Hospice needs to have new role and purpose in future city.
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EARLY EXERCISE
The early exercice at the beginning of the semester helps the understanding of the healthcare system and practical side of the design. First exercise is to rethink a medical object in the current hospital. And second is to rethink the co-location possibilities for the hospital.
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Rethinking Medical Object
Traditional Drip Bag
Shoulder Drip Bag
Drip bag indoor garden: The shoulder drip bag could be recycled to do the planting inside the ward. It creates the green space without effort and also push the patients to get up to interact with the plants.
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Industrial building. Co-Location
S W O T
Versatile Space. The industrial structure is flexible and versatile to insert several surprising building function and programs such as library, cinema, gallery or even church. Also its informality gives ability to adapt fast changing society and technology. Factory is not place to die. It is confronting to die in the factory. Traditionally, it is not a decent place to die at. It is challenging to balance the public use of the building and consider the feeling of the inpatients within the space. Non-traditional juxtaposition. It is the opportunity to explore different function and programs into the hospice typology. For instance, a playground tube is easy to insert in a factory space. Also, its non traditional mix function hospice will draw attention from the public to deliver the public health as discussed. Isolation + Surrounding Environment. It is both threat and opportunity for surrounding environment. In one case, the hospice might be isolated from residential areas or it brings life into industrial areas.
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PRECEDENTS
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The precedents that I am looking at is focusing on the different aspects of the hospital physically and psychologically. The japanese buildings are inspiring that how the effiency brings the different psychology to the patients different from the western world.
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Ark by Shin Takamatsu The building is conceived as a huge urban machine replete with sinister high-tech mechanistic detailing. The Japanese are said to feel more comfortable if their medical building look clinical and efficient, like a machine for health, whereas Westerners tend to favour building s which, at least to some extent, disguise the most functionalist aspects of their function. Psychologically, the japanese people think that they feel hospital should be effiecient and fast for healing people. It is naturally not a place to stay but to heal. So be in the space like this, the people in japan feel that they can be healed better and faster, which they think that is what hospital should do.
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Pharaoh Dental Clinics Similar to Ark, since these early, expressionistic structures, Takamatsu has moved to bigger and less eccentric design, but big, complex structures reveal a continuing collision of the spectacular and the mechanistic, a certain appetite for the combination of the theatrical and the functional.
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Fun Palace by Cedric Price Cedric Price’s Fun Palace and his professed interest in time-based, indeterminate, and anticipatory architectures, quickly assembled and taken apart as necessary. From things like automatons, gadgets that twitch and tweet, and fascinations of a wanderer in the midst of orreries, His work implicates curiosities about unpredictable and incomplete worlds.
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Maggie Center by Richard Roger The site is situated in a busy urban context next to a large NHS hospital. There is a high orange-red wall to separate the street and inside, inspired by Maggie’s book on The Chinese Garden. To accommodate the mixture of functions, the architects use Chinese puzzle of square rooms. However, what I am interested in is such layered space, characterized by Van Eyck as “labyrinthine complexity”. These simple squares overlap on each floor and across floor, which allows the veiled communication physically and visually. This strategy help the inpatients to interact with the space, people and movements, feeling that they have freedom and belongings in this space. Its connection and communication is the key aspect from this precedent.
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HYPOTHESIS
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The research we investigate indicates the problems of the bariatric care in the contemporary pratice. However, the culture difference varies the perspective of the hospitals. So there is no ultimate solution towards how and what the patients should be treated. So the project is going to be pushing the condition to the extreme, be provoctive and controversial about how the hospital should be like for bariatric patients. This project provides a critique of this contemporary approach highlighting that, within a context of “patient-centred care�, the experience of bariatric patients has not been seriously addressed. So to promote the efficiency and process-like hospital is the key design directions.
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Program Mapping
From the hypothesis, the building programmes are needed to shift to achieve the max efficiency. The idea is to re-consolidate the current programs into medical and
amenities programs. The two process must be seperated to get the efficiency.
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Ward
Office
Ward
Operation Room Medical Service
Operation Room
Anaesthetic Room Recovery Room
Anaesthetic Room Recovery Room
X-Ray Room CT scan Room
Utility Office Changing Room
Physiotherapy Room
Utility
Changing Room
Reception Waiting Room Consulting Room X-Ray Room CT scan Room Cafe
Physiotherapy Room Reception Waiting Room Consulting Room Cafe
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Amenities/Utilities
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Process 1 : Check In
Reception
Admission/Ticket
Waiting Lounge
Ward
Process 2 : Medical Examination Waiting Lounge 2
Ward
Waiting Lounge
X-ray
CT scan
Process 3 : Surgery Waiting Lounge 2
Ward
Waiting Lounge
Anaesthetic
Surgery
Process 4 : Check Out Ward
Discharge
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Recovery
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Day Surgery Patient Mapping
Space
Check-in
Transfer Lounge
Surgery
Transfer Lounge
ORA1
Surgical Team
ORA1
Check-out
Staff
Standard Transporting Time
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Patient Pathw
Space
Check-in
Transport Process
Process 1
Ward
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Surgery
Transfer Lounge
Process 3
RN Staff
Transfer Lounge
ORA1
Surgical Team
ORA1
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way Mapping
Ward
Transfer Lounge
Medical Examination
Transfer Lounge
Ward
Process 2
RN
ORA1
Radiologist
Check-out
Process 4
ORA1
RN
Standard Transporting Time
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Mechanical Interface
The second level of the efficiency lies in the detail or interface of the building. To rethink and redesign the mechanical system integrating into spatial design, the transition
could eliminate the unnecessary transaction equipments. The idea is to have less equipment and have max performance throughout the process. 64
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Check-in
Check-in
The patients are auto checked-in and carried to the location through the systems.
Ward
Ward Crane has been design as a unify tool for patients to move around in the ward.
Ward
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Transfer Lounge
Transfer Lounge
Just like airport, the transfer lounge is similar to wating lounge at the airport inbetween the check-in and the boarding.
Surgery
Surgery
The future surgery has become a linear surgery process and dominated by robotics to achieve effiency.
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Medical Examination Medical Examination
Similar to surgery process, the medical examination process also become a linear process for effiency.
Day Surgery
Day Surgery A day surgery patients path was described as an efficient and fast process.
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Context
The site is chosen at the adjacent place around Peter Mac Cancer Center to support the need for bariatric patients. Also, the size of
the site is small to medium because of the decentralized future hospital systems. 68
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CARLTON
RMH Fle mi
ng to nR d.
UoM Medical School
VCCC
NORTH MELBOURNE
e zab Eli
CBD
S th t.
The site is situated beside the medical district and UoM medical research area. The building sits at the very busy intersection.
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Massing Study
Similar to patient mapping system, the massing study idea are from the patient path throughout the hospital experience. The planning
of the whole hospital are the combination results of the future hospital mode and contemporary bariatric patients’ path. 72
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Fleminton Rd.
VCCC
Body and Health Creation (heritage)
RMH
N Melbourne Police Stn.
Wreckyn St.
Siles Health
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Check-in
Patient Lift
Check-out
Transfer
Medical Service
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Ward
Check-in
Patient Lift
Check-out
Transfer
Medical Service
Amenities
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Linear Process
Continuous Flow
Program Insertion
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Patient Lift
Ward
Transfer
Medical Service
Amenities/Office
Check-out
Staff/Visitor Lift
Check-in
Patient Lift
Transfer
Medical Service
Check-out
Ward
Medical Service
Amenities/Office
Staff/Visitor Lift
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DESIGN
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Mechanical Interface
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0
2
4m
Ground/Transfer/Check-in The ground has three segments, two entrance and three functions. The check-in area is for patients automotive check-in process and the inpatients will be transferred and merged here to go to the ward. The middle is entrance for staff and visitors. And the third is checkout area for day patients.
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0
2m
Check-in The patients arrive the entrance and facing the auto check-in machine or waiting aside for the calling. And patients find its way to the lift machine to be transferred to further location.
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Check-in The check-in is totally autonomous, it empowers the patients to have and make their own choice. Similar to airport, the check-in procedure is for logging in the information to the hospital system.
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0
Staff/Visitor Entrance + Check Out
84
2m
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Staff/Visitor Entrance
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86
BARIATRIC HOSPITAL
87
RETHINKING HEALTHCARE
0
2m
Ward Interface The ward interface includes the patients from the check-in point to ward and the movement inside the ward itself and also the transfer procedure to medical service where all happen in one room. The central “crane� is essential for patients to have autonomous movements.
88
BARIATRIC HOSPITAL
0
1
Lift Mechanism The Lift carries the patients from check-in to ward or straight to transfer top area for medical service for day surgery.
89
2m
RETHINKING HEALTHCARE
0
1
Ward Crane The Ward crane is design to be able to transfer the inpatients from the doorway to bed to bathroom. This is a compact device for the future hospital use which includes lighting, hanging bars and sliding lift slings. The patients could move to bathroom with little or no help at all.
90
2m
BARIATRIC HOSPITAL
0
1
Transfer to Transfer The Ward crane is design to be able to transfer the inpatients from the doorway to bed to bathroom. This is a compact device for the future hospital use which includes lighting, hanging bars and sliding lift slings. The patients could move to bathroom with little or no help at all.
91
2m
RETHINKING HEALTHCARE
0
2 4m
Top Transfer Area The Top Transfer Area provides the intersection between the check-in and medical serivce. If the system is like a airport, the transfer area is the waiting and boarding area.
94
BARIATRIC HOSPITAL
0
1
2m
InBoard Section The circular ports are for the inpatients to autonomously arrive the transfer area. And the middle lift tower is for the outpatients to arrive the transfer area.
95
RETHINKING HEALTHCARE
0
1
Patients Transfer Through the ceiling system the patients are able to transfer on the inflation bed into the boarding areas.
96
2m
BARIATRIC HOSPITAL
0
1
Boarding for Medical Service Through the ceiling system, the patients are able to transfer to medical towers, one for exam, one for surgery, to have their services.
97
2m
RETHINKING HEALTHCARE
98
BARIATRIC HOSPITAL
99
RETHINKING HEALTHCARE
0
1
2m
X-Ray Room Different from the traditional X-ray machine, the patients are positioned upright and pass though the machine vertically. The machine itself will be able to reinvented into 3d scan so the patients are not needed to bend the knee or additional gestures.
100
0
2m
RETHINKING HEALTHCARE
0
104
2m
BARIATRIC HOSPITAL
0
1
CT scan Room Also, the CT scan is another common tool for medical examination. The patients can go through the CT scan machine through a vertical movement to achieve the efficiency.
105
2m
RETHINKING HEALTHCARE
0
1
2m
Anesthesia Room The first fragment or procedure for the surgical tower is the anesthesia room. The lift system help to transfer the bed up and down.
106
BARIATRIC HOSPITAL
0
107
2m
RETHINKING HEALTHCARE
0
108
2m
BARIATRIC HOSPITAL
0
1
2m
Surgical Room The second procedure is the surgical room. Based on the future hospital, the hospital will be much more robotic oriented. The circular ceiling rail system helps the movement of the robot and easy to expand for the future robotic equipments.
109
RETHINKING HEALTHCARE
0
1
2m
Recovery Room All stages of the recovery happens in this room. The ceiling system help to transfer the patients from the bed to recovery bed. After the patients are awake they will check-out or rest at ward through the transport using wheelchairs.
110
BARIATRIC HOSPITAL
0
111
2m
RETHINKING HEALTHCARE
112
BARIATRIC HOSPITAL
113
RETHINKING HEALTHCARE
0
2m
Aquatic Therapy Through the research, the aquatic therapy is the best for bariatric patients to do exerise while the damage to the bone joints is minimal. By providing the ceiling system, the patients are able to move around the space and able to exercise and enjoy themselves.
114
BARIATRIC HOSPITAL
Aquatic Therapy Interior Few staffs are inspecting the movement and exercise of the patients. However, the patients are happy to move themselves through the spaces on and off the water.
115
Design Resolution
BARIATRIC HOSPITAL
119
RETHINKING HEALTHCARE
Process Flow
120
BARIATRIC HOSPITAL
121
RETHINKING HEALTHCARE
Structural Resolution
122
BARIATRIC HOSPITAL
Bracing Detail
123
RETHINKING HEALTHCARE
Interior Space 1
Interior Space 2
124
BARIATRIC HOSPITAL
Movement + Communal Space
125
RETHINKING HEALTHCARE
Inflation Transport Bed
Patient Transport Lift
126
BARIATRIC HOSPITAL Detail Section
127
Detail Section
BARIATRIC HOSPITAL
Detail Section
129
RETHINKING HEALTHCARE
130
BARIATRIC HOSPITAL
Inflation Bed Transfer
131
RETHINKING HEALTHCARE
Wreckyn St.
Flemington Rd.
VCCC
RMH
0
10 20m
Site Plan
132
BARIATRIC HOSPITAL
Car Access
Car Access
Flemington Rd.
0
3
6m
Roof Plan
133
RETHINKING HEALTHCARE
Consulting Room
Personal Pod
Ward
Communal area
Surgical Room Preparation Room
0
3
Staff
6m
Personal Pod
Third Floor Plan - Access to Surgical Room
134
Ward
BARIATRIC HOSPITAL
Personal Pod
Ward
Xray Room
Communal area
Preparation Room
0
3
Staff
6m
Personal Pod
Ward
Fourth Floor - Access to Medical Image Room
135
RETHINKING HEALTHCARE
0
3
6m
Aquatic Therapy Floor Plan
136
BARIATRIC HOSPITAL
0
3
6m
Top Transfer Floor Plan
137
APPENDIX
RETHINKING HEALTHCARE
138
BARIATRIC HOSPITAL
Midterm Group Project
139
RETHINKING HEALTHCARE
140
BARIATRIC HOSPITAL
141
RETHINKING HEALTHCARE
142
BARIATRIC HOSPITAL
143
FACULTY OF ARCHITECTURE, BUILDING AND PLANNING Architectural Journal M.Arch Thesis