Cancer Hospital Design by Kunal Jain

DESIGN VI

CANCER HOSPITAL DESIGN

KUNAL JAIN SHIVANI AGRAWAL

CANCER HOSPITAL DESIGN INDORE CANCER FOUNDATION CHARITABLE TRUST INDORE

DESIGN VI III YEAR SEMESTER VI SCHOOL OF ARCHITECTURE, IPS ACADEMY, INDORE YEAR-2016

KUNAL JAIN SHIVANI AGRAWAL

CONTENTS Acknowlagement Preface Project brief

vii ix xiii

The research process Site analysis Room program Design process Detail drawings

1 35 45 53 63

Conclusion Refrences

77 79

ACKNOWLAGEMENT Through the past semester I have been privileged to participate in, hospital construction, courses and events with the topic of the hospitals in Indore, and I have met and interviewed architects, designers, decision-makers and politicians working within this field. In all these occasions, I have received great response and endorsement regarding my preliminary work, and I am deeply grateful for their time and interest. The design could not have been possible without the assistance of the faculty members of the department. Their contributions are sincerely appreciated and gratefully acknowledged. I would like to express my deep appreciation and indebtness particularly to the following: (Prof.)Dr. Kiran P. Shinde, Principal, School of architecture, IPS Academy, Indore. Ar. Deepak Sharma, Visiting professor, School of architecture, IPS Academy, Indore. Ar. Ratima Dagaonkar, Professor, School of architecture, IPS Academy, Indore. Ar. Roopesh Kochure, Assistant professor, School of architecture, IPS Academy, Indore.

A special thanks toAr. Mayur Jain

PREFACE The project is a design project of semester VI, in the School of Architecture, IPS Academy, Indore. The hospital will function as a centre for treatment of cancer, and provide a homely, welcoming environment, accommodating counselling, therapies, physical activities and creating a social interactive environment. The project takes its point of departure in the theme of â&#x20AC;&#x153;healing architectureâ&#x20AC;?, which declares that architecture can have a positive effect on the healing and health care outcomes of its users. Different research revolving this has resulted in evidence, which prove that different architectural elements, such as light, acoustics, relations to outdoor, social space as well as private space have a profound effect on health care outcomes. NATURAL DAYLIGHT To minimize the energy used for lighting, natural daylight should be utilized through careful orientation and optimization of the building layout and plan. Deep rooms should be avoided and the functions should be zoned within the building, so activities requiring high illumination are placed near windows. Further it should be considered, how to avoid glare and overheating, as the daylight changes through days and seasons. VENTILATION Energy for ventilation and cooling can be reduced by use of natural ventilation. Different initiatives can be implemented to naturally preheat the air. Natural

PREFACE

ventilation depends on the climate conditions, changing through days and seasons, and it can be difficult to plan the precise effect. VIEW AND ARTWORK Connection to outdoor environment and appropriate artwork can help to create a supportive environment for faster healing of patients. These visual connections engage the patients for some time thus, distracting them from their pain and stress. SOCIAL INTERACTION The planning and the interior decoration are important in relation to optimize the health care settings for privacy as well as social interactions. It is important to create spaces for people to be private, facilities, where they can keep their belongings and spaces, where they feel a bit in control. Private spaces also comprise spaces to be alone with oneâ&#x20AC;&#x2122;s relatives or closest friends. Furthermore it is important to create common spaces for social interactions, for smaller or larger groups. The common spaces should reflect and accommodate everyday activities, as these are easy to access and take part in even if people are unfamiliar with each other. FLOW Research regarding flow and locomotion in relation to healing architecture is mainly relevant in hospital architecture, as it is often large, complex buildings with extensive navigation systems of signs and numbers. A simple and uncomplicated plan can ease the navigation within the building. Plans with many 45 degrees

PREFACE

corners tend to be more complicated to navigate in, than plans based on parallelism with a clear main orientation direction. The Cancer Health Care centre is a small building compared to a hospital, but it is still relevant to consider the level of clarity and transparency in terms of navigation in the building and more specifically the entrance of building, in order to ease the visit to the centre and avoid that the visitors feel distressed and uncomfortable.

PROJECT BRIEF The forces behind the cancer health care centre are the Indian Institute of Head and Neck Oncology. The centre works in the field of cancer, reaching out to people in remote, rural areas of the region, creating awareness on the importance of early detection and the need to get the right treatment and in all this maintain a special focus on oral cancer, given their high incidence in India. The Indore Cancer Foundation works in a small hospital building with only treatment department which provides therapy for curing cancer. They plan to expand it into a specialist cancer care treatment hospital which will serve cancer patients. All successful hospitals, without exception, are based upon a triad good planning, good design and construction and good administration. It is the architects responsibility to translate clinical administrative needs into architectural and engineering, to integrate different departments of the hospital in such a way that different types of traffic flow in the building are as much segregated as possible, traffic routes are kept short and important functions are protected from prying eyes or intrusion. The skill with which the circulation is handled determines the efficiency of the hospital during its life. THE IMPACT OF CANCER Cancer is a widespread and often feared disease because it can affect all people, old as young, healthy as unhealthy and because of the often harsh treatment course and the sometimes deadly outcome. Consequently, being diagnosed and living with cancer bring many unpleasant psychological emotions and reactions alongside physical side effects from the treatment and illness. It is a dreadful disease that affects millions of people all over the world. Cancer patients spend a lot of time at hospitals depending on the severity of their disease. In India it is estimated that there are 2 to 2.5 million cancer patients at any given point of time with about 0.7 million new cases coming every year and nearly half die every year. Two-third of the new cancers is presented in advance and incurable stage at the time of diagnosis. xiii

PROJECT BRIEF

xiv

The World Health Organization has said that there could be 50 million new cancer patients by 2020. In India there are 30 lakh cancer patients (till year 2013), the Government hospitals that have cancer treatment facilities tend to pay no attention to the quality of spaces and the impact it makes to the human psychology.

THE RESEARCH PROCESS

Health services require a wide range of buildings of very different sizes and types. Hospitals may be sub divided into the following categories: smallest (up to 50 beds), small (up to 150 beds), standard (up to 600 beds) and large hospitals(more than 600 beds). Very few of the smallest and the large category hospitals have been built in recent times, the trend now seeming to be to create an even coverage of small and standard hospitals. In fact, modern health reforms have produced a noticeable reduction in the numbers of the smallest hospital. Hospitals are divided by function into general, specialist and university hospitals.

THE RESEARCH PROCESS

SIZE AND TYPES OF THE HOSPITAL

General hospitals: A general hospital provides a range of medical services including: consultations, treatment, diagnosis, minor surgery and health education. Sometimes it may also include day care for physiotherapy and occupational therapy and out-patients emergency treatment. In some cases there may be in-patient short stay beds. These centers can offer great flexibility and tend to serve an average population of 10,000 to 30,000 people. Specialist hospitals: The number of specialist hospital is growing fast because of the increasing focus on individual types of treatment or medical fields: causality, rehabilitation, allergies, orthopedics, gynecology etc. also included in this category are special clinics dealing with, for example, cancers, skin problems, lung conditions, psychiatric disorders, and the like. University hospitals: University hospitals with maximum provision are to be considered equal to the medical academies and some large general hospitals. They have at their disposals particularly extensive diagnostic and therapeutic facilities and systematically carry out research and teaching. Lecture theaters and demonstration should be included in such a way that operations are not interrupted by the observers.

THE RESEARCH PROCESS

SPACE AND STANDARDS SITE ENTRANCES There should be three prominent entrances to the site: Main entrance: This is the main entrance for visitors, doctors and hospital staff. It should be the widest entrance as it will be used by maximum people approaching the hospital. The pathway should clearly lead to entrance foyer and parking. Emergency entrance: This entrance will be exclusively reserved for the ambulance and emergency cases coming to the hospital. Service entrance: There should be a separate entrance for services required in the hospital. This will not disturb the main traffic flow in the hospital; moreover some services should be kept hidden from the visitors. The pathways from these entrances should not intersect each other as it will disturb the function of each entrance. These pathways should have multiple lanes to maintain continuous flow of traffic.

PARKING A reserved parking should be provided for doctors and other hospital staff. This reserved parking can be separated from the main visitorâ&#x20AC;&#x2122;s parking or it can also be placed away at a different location on the site. Parking space for public transport such as taxis can also be provided. This will be convenient for the visitors using public transport.

ENTRANCE FOYER Introduction of character to the main entrance helps people identify it more readily and can create a sense of uniqueness, friendliness and individuality for buildings that often seem institutional or faceless. High and generous entrance ways feel welcoming and uplifting. Low or narrow entrances are claustrophobic and oppressive, not easily identified and can cause uncertainty. There should be uninterrupted and clear views of the entrance from the approach to the site.

THE RESEARCH PROCESS

RECEPTION The reception, information or help desk should be immediately apparent but not prevent people seeing the rest of the space or become an obstacle in itself. Being able to see shops, cafĂŠs, toilets, cash machines and other facilities from the entrance makes people aware of them and reduces the need for signs. Being able to see staircases and lifts from the entrance helps people find their way more quickly.

THE RESEARCH PROCESS

CORRIDORS Recessed seating areas along corridors provide places for patients and staff to meet and rest. Seating that coincides with views from corridors to the outside offers beneficial respite for patients, staff and visitors. Typical routes along corridors can be suggested by materials and colours on walls and floors. Projecting signs are easier to see when walking down a corridor than signs fixed flat against the wall. Creating landmarks with art, sculptures and design features helps navigation. Views from circulating spaces into bed and patient spaces should be limited.

ADMINISTRATION The extent of offices provided in the hospital depends on whether they are also the headquarters of the Trust. Main functions include Trust Board and Secretariat, finance, personnel, supplies, and senior nursing and other professional staff. Ancillary spaces include computer facilities, stationery and other stores. The reception desk and enquiry desk should be associated with the main entrance. Other administrative functions do not need priority locations, and may be on an upper floor.

ACCIDENT AND EMERGENCY (A&E) The accident and emergency department should be near the hospital entrance. It should be in a good proximity with the main entrancevv, the pharmacy and reception and enquiry desk. Its access should be through a ramp and there should be enough space outside the department where the ambulance can be parked. This department should have a lift specifically for critical cases. It will also have a minor OT, causality, and a doctorâ&#x20AC;&#x2122;s cabin, who will supervise the department.

OUT-PATIENT DEPARTMENT (OPD) The contracting out of services following health reforms has freed space in many hospitals. Much of these has been converted into day clinics for patients who are only cared for during the day and do not require hospital beds, or who have undergone outpatient surgery.As these patients are 6

THE RESEARCH PROCESS

divorced from the rest of the hospital activities it is necessary to provide a separate entrance to them. Out-patient surgeries for minor operations are becoming increasingly common. In a hospital, the outpatient surgery should be close to emergency room and surgical department. The sequence for the patient is reception, registration, waiting and consultation. A general waiting area should be provided for family with a refreshment counter and a childrenâ&#x20AC;&#x2122;s play room. It should have a close proximity with radio diagnostic facilities, pharmacy, physiotherapy (if possible).

Standards for consultation rooms in OPD

THE RESEARCH PROCESS

DIAGNOSYS DEPARTMENT All the diagnosis units like X-ray, CT scan, MRI etc. falls under this head. There are standards which have to followed while designing these units as some of them may radiate harmful radiations. The units areDIAGNOSTIC X-RAY SUITE The diagnostic x-ray department should be located at the first floor, conveniently accessible to both in-patients and out-patients. It is desirable to locate the department as close to the elevator and adjoining the outpatient department and near other diagnostic and treatment facilities. The staff needed for this department includes: 1 radiologist, 2 or 3 technicians, 1 secretary receptionist, 1 clerk. Darkroom is located between the two x-ray rooms to facilitate handling of films. The films are loaded and unloaded on the counter. Space is provided for loading and stacking films at both ends of the counter. A light lock between the darkroom and light room equipped with interlocking door is necessary to allow entrance into the darkroom of other personnel during film processing.

THE RESEARCH PROCESS

NUCLEAR MEDICIND AND GAMMA CAMERA The treatment of patients with radiotherapy mostly, but not exclusively, cancer patients â&#x20AC;&#x201C; requires specific provision of protected facilities. The general departmental requirements are not dissimilar to those of diagnostic imaging departments, with the need for reassuring reception and waiting spaces and, as all the treatment rooms are internal, for as much of the general departmental spaces to have daylight and outlook. With the more complex modalities, such as linear accelerators, the physics requirements are highly specific and complex, such that these very high powered machines usually are given their protection by housing them in a massive concrete bunker with maze entries to prevent irradiation leakage. Nuclear medicine involves the use of radio isotopes in diagnostic or therapeutic mode. The process embraces: The preparation of the isotopes Their injection into the patient Tracking them in the body Measuring the rate and degree of their uptake using gamma cameras.

THE RESEARCH PROCESS

Therefore a nuclear medicine department must contain a radiation protected isotope store, a laboratory for manipulation and preparation of the isotopes, and a gamma camera room or rooms where the procedures will take place.

LABORATORY

Locate the department as favorably as possible for the laboratory staff and the ambulant inpatients and outpatients. A space on the first floor near an elevator is preferable. In determining the overall size of the laboratory, the first concern is the individual technical units. It is only after the size of these units has been established and an architectural layout has been developed to fit the program that the sum of the areas can accurately reflect the size of the laboratory department. The laboratory services of a general hospital would require work areas for six main technical units: Hematology,blood bank, urinalysis, biochemistry, histology serology and bacteriology.

Cobalt-60, treatement room: Plan

Section A-A

In radiotherapy, conditions diagnosed in the diagnosis department (e.g. tumors) are treated. The different rooms which support the therapy units are reception area, console room, the machine room, UPS room, TPS room (Treatment Planning System) and store. The room size may vary to suit different manufactures equipment. A room approximately 4500mm to 5500mm plus necessary entrance maze will accommodate most of the machines commercially available. Shielding is very important with this unit as the rays are very harmful for humans. Therefore thick concrete walls are made and these units are planned in the basement of the building so that the radiations gets absorbed by the earth and architects should try not to place any other function beside this. The walls, floor and the ceiling are all made up of concrete. The shielding necessary should also be considered for doors and other openings. In designing the door of such room, a good practice is to have a door of wood with a layer of lead on it.

THE RESEARCH PROCESS

RADIOTHERAPY UNIT

Section B-B

THE RESEARCH PROCESS

SURGICAL SUITE The surgical suite of the hospital is a very complex workshop. There may be different number and different type of operating rooms. In general hospital all major operating rooms are identical as to facilitate scheduling of various surgical procedures.The planning and equipping of each operating room is based on a series of questions, such as: size, usage, lighting, intercommunication, electric equipment and monitoring system, service line such as suction, oxygen, nitrous oxide and air, provision for TV cameras, safety precautions in hazardous areas and storage cabinets. The average size of the operation theater is around 40 sq. m. Administration area, scrub area, work and supply room, laboratory, postanesthetic recovery, lounge, locker and toilets for various personal groups and circulation within the department. Within the surgical units we have three basic zone predicted on three types of activity and circulation involved and degree of sterility to be maintained. Outer zone: Administrative elements and basic control where personnel enters the department, patients are received and held or send to proper holding areas of inner zones; conference room, locker spaces, any outpatient reception etc. Intermediate zone: Predominantly work and storage areas; outside personnel will deliver to this area but should not penetrate the inner zone. The recovery unit if integrated with surgical suite, is an intermediate or outer zone activity. Inner zone: The actual operating room the scrub area, the patient holding or induction areas. All alien traffic should be eliminated. Here we want to maintain the highest level of cleanliness and septic conditions.

Circulation in OT Suite

OT suite by Trojan structures limited. Three standard 12X2.4m ISO containers arranged side by side. The unit includes a flexible corridor link for connection to existing buildings and a roof mounted air conditioning package. Electrical switchgear and medical gases are accessible from outside the unit.

THE RESEARCH PROCESS

The surgical suite location must mesh with the total circulation pattern so that the patients can be moved to and from surgery within a minimum of travel through other hospital services. The Intensive Care Unit (ICU) is generally placed close to the operation theater as the patient who has just gone through a surgery is under direct supervision of the doctors and nurses. After the doctors feel that the condition of the patient is stable they transfer them to their wards or rooms. The air conditioning in the OT is different as in other areas. It is centrally air conditioned in which purified air enters through ceiling and after some time it gets sucked by the vents present at the bottom of the walls. 15-20 air changes per hour are required to ensure adequate decontamination of the air between operations.

Patientâ&#x20AC;&#x2122;s Circulation Doctorâ&#x20AC;&#x2122;s Circulation Utilities from Central Sterilization Utilities from SUb-Sterilization Circulation in OT Suite

Operation theater: Section

THE RESEARCH PROCESS

IN PATIENT BEDS (WARDS) The patients who lives in hospital while under treatment or the patients who need all time attention of hospital staff and access to hospital services are admitted in rooms or wards. Broadly they are further classified asPrivate rooms:These are single bedded rooms with an attached toilet and another bed for the visitor, other facilities like dining space, lounge etc. increases with the increase in tariff rates. Semi-private rooms:These rooms may be double-bedded or four-bedded with a common toilet and a bed for visitor with each patient bed. General ward:Wards are big and long rooms with preferred range of 20-30 beds. It may have one or two toilets which will be shared by all. hey are categorized as male and female wards. In some places we may also find mixed-sex wards.

Private room

Space Design Creating zones for patients, visitors and care takers within the bed place helps each feel a greater sense of ownership and belonging. Providing opportunities for displaying pictures and other personal possessions is important. Visual and audible privacy for patients undergoing treatment are crucial to maintaining patient dignity. Furniture, screens and the positioning of beds can create a more personal space in multi-bed rooms. Daylight All bed places should ideally be exposed to daylight. The beds should be placed parallel to the exterior wall, so that the patients can look out of the window without facing directly into the bright sky. Daylight is important for confined patients to maintain a sense of time and natural body rhythms. A lack of daylight will depress confined patients and could add to despondency. 14

Semi-private room

Furniture standards in rooms

FURNITURE STANDARDS Care takers must have access to at least one side of the bed. Doorways and circulation space must allow for trolleys and wheelchairs. The size of the adjustable bed is 2200mm by 610 mm with and adjustable height of 550mm to 900mm. The typical bedside table measures 400mm to 500mm.The wardrobe of size 550mm by 2100mm and 550mm deep is sufficient (this size may vary).

THE RESEARCH PROCESS

Direct sunlight should be avoided or shaded as it can be uncomfortable and irritating for patients in bed who cannot avoid it. Bedside controls of blinds and curtains helps reduce frustration and restores a sense of independence.

TOILETS 1500mm by 2500mm are the dimensions noted for individual -toilets. The toilet door swing out into the bedroom, except where surface bolted or pivoted hinges are used, so that the door can be removed in the event a patient in toilet faints and fall against door.

THE RESEARCH PROCESS

UTILITIES The oxygen is piped in from a central source in most rooms. Outlets are 1200mm to 1600mm above floor level. The suction outlets are either grouped in same plate with oxygen or they are separate, beside or below oxygen. PORTABLE BEDSIDE PANEL Nurse call switch, pilot light Monitor light Reading light switch Room thermostat remote control Electric clock Provision for TV remote control Provision for telephone instrument WARDS All wards need to be easily accessible from the hospital’s main supply and disposal routes. In addition all wards should be capable of being reached by visitors along simple and coherent routes from which they are unlikely to stray into other parts of the building. Contiguity of planning between one ward unit and another is an advantage, for it offers some measures of nursing flexibility between adjacent units. The breaking down of each unit into smaller base or rooms can also provide some flexibility in the numbers admitted of each sex.

Half a ward floor at Yerk General Hospital, comprising four 30-bed nursing units, each with one nurses’ station. Each unit has five single-rooms with five multi-bed bays of five beds; the single rooms in the cross links are ‘swing beds’ and maybe used by either of the two flanking units as required. Day, dinning and TV rooms are shared between adjacent units. The ward building is four stories in height and is naturally ventilated. Architects: Liewelyn-Davies Weeks

Looking at the examples of hospitals, the form and the position of the buildings are an important aspect. The form can influence the comfort of the user. The size and complexity of hospital can be daunting to staff and visitors, and can be overwhelming to ill and anxious patients. Simplicity of access to and between the areas generating most traffic is essential. Although the fire risk in the hospitals are low means of escape criteria and stringent. This is because of the high proportion of people who are unfamiliar with the detailed building layout and include the bed-bound, sick and those with disabilities. It is good advice that â&#x20AC;&#x153;the way-in should also generally be the wayoutâ&#x20AC;?: in other words, evacuation will be most effective if it is by well-known and well-used routes. There may well be conflict between planning in a form loose enough to provide for future change and expansion and the distance that staff and patients need to travel to get from one place to another.

THE RESEARCH PROCESS

FORM AND VENTILATION

HIGH OR LOW? The taller the building, the more inherently expensive, especially as the proportion of floor space occupied by stairs, lift and shafts increases with height, as does the need for total artificial ventilation. Lately, the lifts in some tall hospitals have proved inadequate to cope with the greater volume of vertical travel caused by shorter and more intensive in-patient stays. Horizontal contiguity of functionally related departments has been a guiding principle. That is, functionally related departments should be if possible close to, and on the same level at each other. This avoids time wastage, especially when moving supplies, equipment, and patients on trolleys and in wheelchairs. Also, to be fairly close to the ground, to open a window, to smell the world outside may reassure the patient that he is still connected with the outside world. I established for me a system of broadly two type namely horizontal forms and vertical forms. These are further classified according to different plan forms. This system helped me to analyze the advantages and disadvantages of different forms and the influence of the form on the use of the building. The forms are based mostly on simple shapes or shapes composed from simple shapes. This is influenced mostly by the fact that simpler solutions may also offer a psychological advantage for staff and patients, particularly for patients who suddenly find themselves in an alien and disturbing world of medical procedures and unnatural interventions. 17

THE RESEARCH PROCESS

Central Large Courtyard

THE RESEARCH PROCESS

HORIZONTAL

A central large courtyard results in a single long main hospital street carrying traffic of all hospital departments. These courtyards are also not used by in-patients due to its public nature which makes it noisy and fails to give privacy to the patients. The form is less flexible for future expansion needs as it is inward looking and have only a single circulation system.

Faculty of Medicine, Carl Gustav CarusWV Tech. University

THE RESEARCH PROCESS

Integrated Small Courtyards

Small courtyards offer a lot of advantages over a single central courtyard in hospital planning. Small courtyards act as semiprivate zone for different wards while a large courtyard is more public and thus less used by patients.This form also separates main hospital street from sub streets of different departments which considerably reduce traffic.Shaded internal courtyards acts as light source for the circulation corridors as well as other hospital areas like wards and waiting areas, where light and plantation in the courtyard pleases the patients and helps in faster recovery.

Vivantes Clinical Center, Spandau Berlin

Vivantes Clinical Center, Neukolln, Berlin.

THE RESEARCH PROCESS

External Small Courtyards

This form has a main central spine, from which long fingers enclosing courtyards are developed outwards. The main spine acts as the main hospital street which can be extended further to provide for future expansion needs, though the presence of single spine elongates the horizontal distance between departments.

University Centre, Ulm.

Helios Clinical Centre, Berlin-Buch.

THE RESEARCH PROCESS

Internal and External Small Courtyards

These forms have same features as the integrated small courtyards with some additional features. They further divide sub-street into secondary streets which further distributes traffic flow. These plans also provide courtyard on both the sides which allows for greater depth of rooms and also optimizes cross ventilation.

North Tyneside District General Hospital

THE RESEARCH PROCESS

Central Large Courtyard

In case of tall hospitals a central large courtyard acts as an advantageous built form. The courtyard helps in optimum ventilation of all departments and acts as a light well for all floors. This type of courtyard planning is well suited for tropical climates.

Al-Karma Hospital, Baghdad

THE RESEARCH PROCESS

Solid Form

Solid tall hospitals have more disadvantages over other forms. Absence of courtyard results in use of more artificial light which consumes more power and it do not give comfortable and pleasing environment for the ill. These types of buildings do not have optimum ventilation and thus rely on artificial ventilation systems which are more expensive.

Apollo Cancer Hospital, Chennai, India.

THE RESEARCH PROCESS

External Large Courtyards

In tall hospitals External large courtyards have same advantages as internal large courtyards. In addition they provide better circulation and separation of departments and a better penetration of natural light into the building if there are multiple external courtyards.

Bombay Hospital, Indore India.

THE RESEARCH PROCESS

INFERENCE

RIBBON WINDOWS

GLASS FACADE

According to my study there are four major types of façade used in hospital buildings. According to my site, i.e. Indore, India which is a tropical zone sun is the major issue. Thus fully glazed façade is not preferred in this region. Ribbon windows is a good façade option as it provides a clear view and it allows optimum light and wind inside the building. The heat gain can be controlled by providing structural shading divides such as push in or pull out systems or external shading devices such as louvers. The advantage of using louvers is that they can be designed according to the need of different building facades which can efficiently manage light and heat gain. It is possible to change the strategy of the shading on different façade fronts as each façade receives sun at different angle with different intensity.

THE RESEARCH PROCESS

STUDY OF FAÇADE AND SHADING DEVICES

SKIN

LOUVERS

THE RESEARCH PROCESS

RIBBON WINDOWS

GLASS FACADE

SKIN THE RESEARCH PROCESS

LOUVERS

THE RESEARCH PROCESS

INFERENCE

As the inevitability of growth and change has come to be realized views have been expressed during the last few decade which maintain that, wherever it is situated, a hospital is never likely to be complete. Hospitals are built in several phases or are added in stages to existing hospitals. As the building will inevitably require alterations and additions during its working life, from the outset its physical organization should be conceived with this in mind such as to allow a variety of extension possibilities.

THE RESEARCH PROCESS

GROWTH AND CHANGE

THE HOSPITAL STREET It is desirable to provide strict segregation between the streets for supplies or other goods and those for people, although by the disposition of departments it may be possible to avoid serious conflict between the major categories of traffic, both from point of view of its density and of potential risk of cross infection. It is advisable to separate the main circulation spine from secondary circulation of smaller departments; this distributes the traffic flow from the main street which reduces chaos in corridor areas. The hospital street can have impact on future growth and expansion. A single continuous spine allows expansion by expansion of the street while a closed loop type street is difficult for future expansions.

THE RESEARCH PROCESS

PROXIMITY CHART

THE RESEARCH PROCESS

FLOW CHART

site analysis

The site provided for this design project belongs to Indore Cancer Foundation Charitable Trust in Rau, Indore district, Madhya Pradesh. This site is proposed for Cancer Hospital according to Indore master plan 2012. The site is located in Rau adjoining the IIM Indore campus. The coordinates are22.71Â° N, 75.85Â° E There are three existing build blocks on the site, two small hospital buildings and a guest house. There are two ways in which we can proceed to design the hospital, either by retaining the existing buildings or by demolishing it.

SITE ANALYSIS

SITE

SITE ANALYSIS

CLIMATE SUN Indore being a region with composite climate experience harsh summers and moderately cold winters. Sun is an important factor affecting the design in composite climates. Winter sun is at a lower angle then the summer which demands for design allowing winter sun inside the habitable spaces while blocking it during harsh summer months. East and west facades receive maximum heat load which makes east-west orientation favorable. Zoning of spaces inside the building is also of concern while designing keeping sun as an issue. Patient departments which include their stay (Wards and rooms) should preferably zoned in north side which allow for glare free light inside. Non habitable spaces like services and parking can be zoned in west and southwest to act as buffer zone. Operating theatres and diagnostics department which are inward looking rooms can be kept in south with suitable shading to walls to control heat gain.

Prevailing wind direction is south-west to north-east while the winter winds prevail from north-east to south-west. Building openings and site surroundings are to be designed accordingly allowing summer wind inside and blocking the winter ones.

SITE ANALYSIS

WIND

SITE ANALYSIS

CONTOUR Contour or topography of the site is an important factor which will largely affect site planning and micro climate of the area. The given site has a varying contour with slope varying from 1:25 to 1:40. the main build blocks should be placed on high ground to avoid drainage flow inside the building during rainy season. the sewer services drains to the road side at the point with lowest level so that mechanical power to drain out sewage is avoided.

SOIL AND VEGETATION Indore is a region with black cotton soil. This soil is loose in nature and thus type and depth of foundation is to be considered while choosing the type of foundation. The depth of foundation varies from site to site depending on where the hard strata or yellow soil is found, thus depth of foundation is equal to depth of the hard strata. In case soil is too loose raft foundation is preferable. Black soil is good for numerous plants and shrubs. On the given site there is scarce vegetation with very few trees which include neem, gulmohar and bamboo. there are few shrubs also present on site most of which have dried. The present state of site has scarce vegetation and a lot of landscape need to be worked upon in order to shade outdoor open spaces as well as the build form. Deciduous trees grow in this region, some of which are teak, sal, sandal wood, deodar, bluegum, ebony, sisam, jack-fruit, mahua, palash, arjun, khair and bamboo. These trees cultivate in black soil and are also suitable for composite climate.

LOCATION MAP The site is located in Rau, Indore district. It can be approached either by CAT road, or by another road which connects NH3 to Rau-Pithampur road. There are secondary roads which connects the site to these main roads.

SITE ANALYSIS

MAN MADE FEATURES

SITE SURROUNDINGS Towards the north of the site there are two residential buildings, to the east is a warehouse with a truck bay, to the south is a farm land and IIM campus at the west. There are also two roads which divides the site in three parts. The north-south road is 4m wide and the east-west road is 6m wide. Residential building- These are two light colored medium rise buildings of concrete with flat roofs and horizontal louvers

SITE ANALYSIS

VEHICULAR AND PEDESTRIAN MOVEMENT Both the roads don’t have much traffic on them as they are quiet narrow and they do not connect major areas.

VIEWS Considering the views (to the site and from the site) both are very curtail. The façade, the exterior spaces and the departments will be placed only after drawing the inferences considering the “views”.

SITE ANALYSIS

VIEWS TO THE SITE

VIEWS FROM THE SITE

SITE ANALYSIS

IMPORTANT VIEW POINTS TO THE SITE

ROOM PROGRAM

vvv

the design process

The first stages of the conceptualization process evolve around studies of the building volume, the square meters and how they fit on the site. These different morphologies are studied with considerations for contextual as well as functional parameters, considered in terms of internal and external qualities.

THE DESIGN PROCESS

1. MORPHOLOGY

It is found important that the building defines and creates outdoor spaces on the building site. This will give close connections between internal and external functions and create distances to the surrounding buildings, complying with the context. In relation to the evidence based design guide, it is important to have a clear overview of the building. In the case of the Cancer Health Care Centre, there are many functions of different character, some which are for drop-in visits and some for appointment visits, and some are just for administration. Thus it is found essential to create a clear overview of the various functions in terms of the functions relating to the users and visitors of the centre and the staff related functions. The possibility of a overview is seen as an external as well as internal parameter, relating to the morphology or the layout of the building, as it draws the outlines of the possible internal organization. It also becomes important in relation to creating easy access between the internal functions in terms of short distances. The morphology further relates to the light income of the building in relation to its depths. A fragmented volume can give a clear expression of the division of spaces or zones inside the building, it can create spaces around it and enable less deep volumes meaning better daylight conditions. Spreading the volume too much will however result in larger internal distances, which can also interfere with the overview of the building. To ensure a building volume, which gives space around it, has an appropriate depth and has a layout, where large distances within the building are avoided, it can be necessary to build several storeys, why the recommendation from the competition program will need to be reconsidered.

THE DESIGN PROCESS

2. INITIAL SKETCHING Early sketching processes lead to an initiating idea of the symbolism in the architectural expression. The Cancer Health Care Centre is to provide a safe, healing environment protecting the cancer diagnosed people from the outside world, giving them an oasis, where they can meet and relax and get a break from the tough reality they live in. This should be expressed in the architecture of the building and the initiating ideas evolve around the concept of embracement, where the building embraces or wraps itself around its users.

Diffrent compositions were sketched by placing the blocks in proximity and creating diffrent internal and external courtyards was the aim. The composition with offered the best view, daylight and air flow in the building was selected.

ALL THE AREA PROVIDED ARE LAID OUT ON THE TWO STORIES ON THE BUILDING SITE

THE BUILDING IS THEN DIVIDED ACCORDING TO DIFFRENT FUNCTIONS AND THE BLOCKS ARE THEN SIZED ACCORDING TO THE AREA REQUIREMENT OF EASH DEPARTMENT

The initial sketching of an architecture with an embracing expression, develops further into ideas of a wrapping facade structure embracing and protecting an internal building core.

THE DESIGN PROCESS

3. CONCEPT AND FORM EVOLUTION

The concept of Healing Architecture can be achieved by providing various elemants in the building likeGood daylight quality Efficient air flow View and access to nature Open floor plans and flowing space Personal and social space for interaction These elements should directly affect the five senses of the people.

THEN THESE BLOCKS ARE ARRANGED ACCORDING TO THE PROXIMITY AND INTERDEPARTMENTAL RELATIONSHIPS BETWEEN THEM.

VARIOUS INTERNAL AND EXTERNAL COURTYARDS ARE THEN CREATED WHICH CREATES BETTER CONDITIONS FOR LIVING WHICH ALLTOGETER HELPS IN HEALING ARCHITECTURE.

THE DESIGN PROCESS

MORPHOLOGY The first stages of the conceptualization process evolve around the wide range of issues connected with the hospital buildings. To be able to design a hospital means to understand the basic problems. According to inferences from casestudies a real big issue is that hospital buildings are considered as boring and sad buildings. Moreover, wayfinding for a layman in the hospital building is a very difficult job. Thus there is need for spaces which are non monotonous and interesting which will engage the user into its beauty and thus relieves the patient from stress for sometime. These spaces due to their unique character will also help layman to easily mindmap the campus which leads to easy wayfinding. Aggregation of the geometrical regular shapes will help evolve above mentioned spaces. The voids in the mases will also help in optimum ventilation and provide for daylight spaces throughout the campus.

Aggregate is material or structure formed from a mass of fragments or particles loosely compacted together. Aggregation of two or more regular geometrical shapes creates compositions which are unique in character and thus makes the architecture it creates interesting.

THE DESIGN PROCESS

INITIAL SKETCHING

For this project I chose hexagons and parallelograms for the aggregation process. The process of aggregation helped me to form compositions which have masses and voids which are different in form yet forming patterns of similar kind. Regularity in the geometrical forms help to make harmonious composition, thus gives a balance in the overall geometry. The compositions largely emphasised on the masses and voids in order to find courtyards and small social spaces which will occupy the patients and their families. Green volumes are incorporated with the concrete volumes to develop a soothing environment which will help in psycological healing of patients.

THE DESIGN PROCESS

DESIGN DEVELOPMENT 1. The process of aggregation of parallalogram and hexagons to form compositions which have masses and voids which are different in form yet forming patterns of similar kind.

2. Reagrigating the same geometry in accordance with the areas and zoning to give architectural meaning to the 2-D composition.

3. Recomposing the compositions according to builtform requirements I found spaces which are unique, interesting and thus helps in mind maping.

4. Giving volumes to the 2-D composition helps in understanding the volumes created and and study of height along with areas.

5. Alterations in the volumetric mass to create voids helps in better understanding of form

6. Changing volume of every singular mass helps to achive the final form with varying levels which provides open spaces in the vertical growth. 60

THE DESIGN PROCESS

4. FUNCTIONS From the morphology studies it is concluded, that a fragmentation of the building volume will create better conditions for outdoor spaces, better light income as well as a clear overview of the functions in the building from the outside and the inside. The function programme is further developed to investigate which functions need to be expressed in the building volume, and how the building can be divided in an appropriate manner improving the overview of the functions for the cancer patients. Having each function area stand out as a clear entity, seems to create clarity, but also gives an organization, where the different functions and facilities cannot interact much. For instance it is important that the conversation rooms can be easily reached from several places in the building, why placing them in a separate unit seems inappropriate.

FUNCTION DIAGRAM The diagram seeks to clarify the functions within the Cancer Health Care Centre and how they interact. These diagrams shows connection between diffrent rooms in a perticular department, their relationship and proximity to each other.

THE DESIGN PROCESS

RECEPTION

EMERGENCY DEPARTMENT 63

THE DESIGN PROCESS

OPD

DIAGNOSIS DEPARTMENT 64

THE DESIGN PROCESS

RADIOTHERAPY DEPARTMENT

DETAIL DRWAINGS

SITE PLAN

DETAIL DRAWINGS

BASEMENT FLOOR PLAN

GROUND FLOOR PLAN 70

DETAIL DRAWINGS

FIRST FLOOR PLAN 71

ELEVATIONS

RIGHT ELEVATION

LEFT ELEVATION

FRONT ELEVATION

DETAIL DRAWINGS

SECTIONS

DETAIL DRAWINGS

SECTION A-A’

SECTION B-B’

DETAIL DRAWINGS

ENTRANCE VIEW

EMERGENCY ENTRANCE VIEW

OPD ENTRANCE VIEW

DETAIL DRAWINGS

OPD COURYARD VIEW

CENTRAL COURTYARD VIEW

DIAGNOSIS COURTYARD VIEW

DETAIL DRAWINGS

ARIEL VIEW

OPD LOUVERS VIEW

CAFE ENTRANCE VIEW

DETAIL DRAWINGS

OPD CUT SECTION

OT SUITE CUT SECTION

WARD CUT SECTION

DETAIL DRAWINGS

SERVICE DETAIL

TREATMENT CUT SECTION (GROUND FLOOR)

TREATMENT CUT SECTION (BASEMENT)

DETAIL DRAWINGS

LOUVERS

COLUMN DETAIL

DETAIL DRAWINGS

CIRCULATION AND ZONING

SITE VIEW

DETAIL DRAWINGS

GROUND FLOOR PLAN 1:700

DETAIL DRAWINGS

FIRST FLOOR PLAN 1:700

DETAIL DRAWINGS

SECOND FLOOR PLAN 1:700

DETAIL DRAWINGS

REHAB PLAN 1:700

88 SECTION B-B’

SECTION A-A’

DETAIL DRAWINGS

WEST ELEVATION

EAST ELEVATION

SOUTH ELEVATION

DETAIL DRAWINGS

BLOCK MODEL

DETAIL DRAWINGS

CUT-SECTIONS

OUT-PATIENT DEPARTMENT

RECEPTION & ADMINISTRATION

ACCIDENT & EMERGENCY 91

DETAIL DRAWINGS

ENTRANCE VIEW

VIEW FROM PARKING

DETAIL DRAWINGS

VIEW OF THE CENTRAL COURTYARD

CONCLUSION The project brief demanded to design a cancer specialist hospital in Rau. The brief clearly stated the demands and the area program of the hospital. After researching on many diffrent hospitals and on the basis of evidence based design, the hospital was designed concidering all the standards and demands by the trust. The concept of healing architecture was followed throughout the design process and the proposed design will perform best in the functionality and will leave a positive impact on the minds of the users of the building.

REFERENCES 1. Time Saving Standards-Building Types by Joseph de Chiara and John Callender 2. The Architects Handbook by Quentin Pickard 3. IS-12433-2 by Bureau of Indian Standards 4. Health Building Note 00-01 5. Cancer Health Care Centre Copenhagen-Process by Anette Vilstrup Nielsen and Line Fogedgaard JĂ¸nsson 6. Health Caring Architecture by Jeppe Mogensen 7. Youth Healing Architecture by Mads Engel and Line Frier