Thesis 2021: A children focused practice concerning the Pediatric care by nancy khilwani

Navyom

A tranquil form of experience 1

DISCLAIMER The thesis/ capstone project is the final year graduate study undertaken at the ISDI - School of Design & Innovation. No part of this document may be reproduced or disseminated in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior written consent of the ISDI - School of Design and Innovation and the author.

N AVYOM A thesis submitted in a partial fulfillment of the requirements for the completion of the course in Interior Design, ISDI - School of Design and Innovation.

To the Department of Interior Design, April, 2021.

It is certified that the work contained in the thesis titled NAVYO M by Nancy Khilwani has been carried out under our supervision and that this work has not been submitted elsewhere for or as a thesis project.

Mrs. Meenal Sutaria

Mrs Divya Vijaychandran

Program Director: Interior Design ISDI - School of Design and Innovation

Thesis Mentor ISDI - School of Design and Innovation

T A B L E O F C O N T E N T S

LET’s BEGIN

UNFOLDING VIEWS

Abstract Thesis statement Introduction Reasoning the purpose Learning the basics knuckle down

What do people say? Impact of built spaces on children Hospital, city and society

DECODING ELEMENTS

Being up-to-date Beginning the journey from local Mixing with the foreign Letter from the game master

SOLVING THE RIDDLE

Looking the existing Why conventional systems failed? Improvised programmes Features of the module Design brief

COMPLETING THE PUZZLE

Site analysis Digging Deep Existing programs of the site Plugging in the module

LOOKING AT THE CANVAS

WHAT NEXT?

105

Moodboard Material boards Plan, section and elevation Service drawings Renders

What’s changed? Bibliography

A c k n o w l e d g e m e n t s

Embarking on such a journey - conducting on primary research and writing of a thesis although a solidary and lonely pursuit, it was only possible in the light of the guidance, wisdom, patience and unflattering support of mentors, fellow students, friends and family. I wish to extend my sincere gratitude and appreciation. A very special thankyou to my Mentor, Mrs. Divya Vijaychandran. She took a chance in believing in my project when i was unsure. I would also like to thank Mrs. Amrita Ravimohan for her guidance, expertise and supervision. Getting through my capstone made me realise the constant support of my parents and my friends who endured this long process with me, always offering support and love.

CreditsDr. Gouri Pandit Shreya Khilwani Shashwat Pradhan Ira Bindal Kashvi Gandhi Suhani Dagur Anusha Mittal Prachiti Kamath

It’s important for healthcare building designers to design specifically for the communities they serve. This is why there is no single architecture style for healthcare buildings. Every design feature should be based on the individual patient and visitor needs. - HMC Architects

LET’s BEGIN.. Healthcare industry has always benefited from the relevance of human-centred design to support efficient and effective services. Despite this, healing characteristics of healthcare environments are sometimes ignored. It’s also been witnessed in the recent past that hospital design also contributes to the healing process and helps have a better chance at being functional and flexible to national crises such as COVID’19. The pandemic has caused enormous pressure and disruption to paediatric services and working lives further adding to challenges of levelling up and making child health a priority. In pediatric facilities, the environments shape the way children look at life and reflect upon it from the interactions they get in these facilities. It’s important to note that they are constantly observing and learning from their environment. Hence, the space may not be looking at a singular function of healing but overall well-being and growth of the child too.

1.1

A B S T R A C T

While certain design elements in the designed facility can be contemplated as disruptive in nature considering the stringent conventional norms of the hospital, certain aspects can be made more mindful and interactive keeping the well-being of the caregivers in mind which acts as supporting characteristics in the environment. Although these specialised hospitals time and again offer a set of unique facilities which provides them the credibility and functionality, there are other integral aspects too which support that environment to complete the healthcare process. A designer’s role brings in that extra added understanding of how beautiful experiences can be created getting directly influenced by design strategies. This capstone looks at implementing and demonstrating various design strategies to enhance a conventional typology of pediatric facilities in order to create a better experience for healing and well-being of children and their caregivers, while adding significant contribution to the healthcare processes.

The capstone aims to propose a module that represents a ‘selfsupporting systems’ approach, enabling an increase of control of design through spatial design settings for a pediatric health facility. These settings will not only relate to the space and healing process but also the space and life progress.

1.2

T H E S I S

S T A T E M E N T

Implementation and demonstration of design strategies to create an ideal module for pediatric facility which facilitates a user-centric approach to enhance user experiences in a fixed environment contributing to the healthcare processes.

https://folk.me/projects/children-hospital-experience-design/

1.3

I N T R O D U C T I O N

‘There’s no doubt whatever about the influence of architecture and structure upon human character and action. We make our building and afterwards they make us. They regulate the course of our lives.’ - Winston Churchill

Since the Modern shift in architecture, hospital design has evolved and adjusted to the changing needs. Nowadays, it is considered to be part of the wellness program and an element within multiple components considered essential towards the program. It is a designer’s duty to design an environment that will propose security and positively affect the patient. However, this task sometimes gets hampered by several situations in practical life and leads back to where it starts, the design process. In order to design a hospital environment which focuses on palliative care, the needs and necessities of its user becomes crucial. Humanizing design means creating better spaces which explore functionalism on a larger scale rather than purely technical. Infact, in present times, a small intentional design can create a huge impact on everyday’s life. The design of healthcare facilities have a similar scenario, it deeply affects the mind and body of a patient during its visit or stay. It’s a complex combination of form, function, social and emotional nuances. Designing one is somewhat like having a conversation, only here the dialogue is between your desired user and the space.

Designing for children on the other hand brings in the bonus of interesting and exciting eye pleasing view’s in addition to the “functional’’ aspect of a conventional hospital. An approach focused on children can shape their experiences and quality of life while also revealing how it shapes values of / towards society. Children are vulnerable, in virtue of their size, their development and behavior, and childhood in general.1 They have fears regarding illness and hospitalization which makes it difficult for them to accept the strange, unfamiliar surroundings being offered for treatment. They are exceptionally sensitive to changing environments which creates stress and fear resulting insecurity, anxiousness, and threat in their minds .Thus, hospital design should offer homely comfort while bringing the outside facilities to the inside.

http://psrcentre.org/images/extraimages/12.%20ICECEBE%20113810.pdf

http://www.behance.net/gallery/Murals-for-the-Emmas-Children-Hospital-Amsterdam/9599729

R E A S O N I N G

“

1.4

‘Children are our future. What happens to children in their first days, months and years of life affects their development, the development of our society, and the development of our world.’ -Bernard van Leer Foundation

T H E P U R P O S E

A designer’s influence can empower the impact of a healthy environment with focus on personalised service and attention, promoting familiarity and well-being. A well-planned physical environment can support the implementation of a high quality program for young children in many ways.

https://www.hrpub.org/download/20191030/UJPH2-17612604.pdf https://www.goodillustration.com/blog/?tag=daniela-sosa 2. 1.

Traditionally, hospital design has evolved over many years, each influencing the other’s outcome combined with the idea of supporting the environment with evolved techniques and awareness.2 The most common questions that facility designers (planners, architects, interior designers) received from healthcare clients were focused on options for creating a more pleasing environment for patients and families. Most of these questions related to the patient room, family and play spaces, grand entrances, and welcoming lobbies.

However, Today, those questions remain, but more commonly, clients not only are asking for, but are demanding, information related to the safest and most comfortable patient room options, the most productive nursing support configurations, the best technology integration plans, the latest communication options, and evidence-based options for creating the optimal healing environment for their patients and the healthiest, most rejuvenating environment for their employees. The main objective is to design effective workflows to make space, equipment and workers more productive in order to maximize the experience for the patients. The design of these institutions look forward to not only considering and responding to known, documented, Evidence-Based Design attributes, but future planning considerations which will be visionary in response to a rapidly changing future. These are bombarded with endless options but the important thing here is to decide what’s best for its users and to plan for what comes next specially in this pandemic.

1.5

L E A R N I N G T H E B A S I C S

The concept of a hospital design matters to revolutionize the healthcare environment for everyone who sets foot in a hospital. All the elements of healthcare are key components for a health care system which contributes in improving the health status of individuals, families and communities. With Proper clinical education and comfortable environments, design can help create a composed background to a rushed one.

‘Yesterday is not ours to recover, but tomorrow is ours to win or lose.’ — Lyndon B. Johnson

1.6

K N U C K L E

D O W N

Awareness about healthy and safe environments with the establishment of medical, psychological and sociological aspects of design creates a base for impulse to the childcare facilities. Childhood presents an important age group, not only because of their dependency to grow up, but because children are in a learning process of knowing themselves and relating with other people and the world around. It is a substructure which defines who the person is, their thoughts, memories, beliefs, values and meanings relating to all important settings of a person’s daily life.

Children are vulnerable, they are sensitive towards their environments and hospitals for one can be an extreme environment for them to cope up with as it challenges their daily routines, which generates responses like anger, frustration, fear and anxiety. A child loses it’s control over things in a setting like this, adding on to the vulnerability. Avoiding negative responses in a hospital environment is a key to support recovery along with age appropriate design. They can also act as factors that can be manipulated to obtain certain positive distractions with Healthcare provisions, Educational distraction, kid-centric spatial design and comfort to its users.

Patient centric care design is starting to be applied and paediatric hospitals are finally implementing and being competitive in society. Many hospitals today continue to appear as places of death, creating a reason for people to avoid. By investigating the needs of hospitalized children in physical dimensions can help change this notion and bring in change to improve these environments.

UNFOLDING VIEWS

“We often trick ourselves into thinking that we possess enough knowledge or control over any given situation to make correct choices. Maybe that is why we hold on to the decisions we make so dearly even when we know we are wrong.” -Spencer Fraseur

2.1

W H A T D O P E O P L E S A Y ?

USER The interactiveness in the surroundings makes us wonder the power of experience and how children’s react to it.

What’s your favor de

With the complex care each individual patient needs alongside the fact that every patient is different from each other and reacts differently with people around makes it difficult.

What do you think a pediat

Children are inherently more social, even when they are not feeling their best. Entering into a unfamiliar environment makes them anxious. Dealing with these emotions can be distractive for parents and for others around.

How does the emo with

Patient flow and wayfinding inside the facility. Children are looking to their parents to guide them through unfamiliar processes and places. If a parent is stressed trying to locate their intended destination, it erodes trust in the bond between parent and child. A simple, easy to understand patient flow allows the parent to focus on their child’s wellbeing.

What is the one thi that cannot be em

rite part in Pediatric esign?

are the complexities of tric care?

otional journey relate design?

ing in pediatric design mphasized enough?

DESIGNER Designing for varying groups, creating flexibility, and understanding complexity is a challenge that stimulates innovation and creativity in the design team. Ultimately, design providing a fulfilling service which promote healing and wellness for children?

Patient conditions and type of facility creates an impact on the kind of space to be designed. It requires a multidisciplinary approch with a coordinated care plan to treat these children in a specific environment.

The ability to process information in kids is not fully formed until our teenage years. So, breaking down the medical experience into moments that can be easily understood allows children to interact with their surroundings in a more meaningful way. Creating environments that promote positive social interactions and meaningful communication— can engage both our pediatric patients and their families. The importance of the patient and family experience is not to be overlooked and is at the core of designs. Creating whimsical, uplifting environments for the social and psychological needs of children helps build trust.

2.2

I M P A C T O N C H I L D R E N

With the growing attention on children and their autonomy recognition has resulted in exploration of different childhood spaces to fulfil socio-cultural context. Increasing public awareness about healthy and safe environments within medical establishments created a base for childcare facilities and user centric care approaches to come together and create a holistic experience. Earlier, the stressful experience of hospitalization hindered the medical processes undoubtedly creating nervousness resulting in the space to be a misfit between the hospital environment and the physical, social and psychological needs of the patients.3 Thus, loss of control over the surroundings created an imbalance in relationship to the environment i.e. need to move around in space, the need to feel comfortable, the need to feel competent and the need to feel in control. Thus, with an understanding of the behavior of children towards the physical environment, the needs transform into design, thus comforting them.4 http://psrcentre.org/images/extraimages/12.%20ICECEBE%20113810.pdf https://gpsych.bmj.com/content/32/3/e100061 4. 3.

Children in the hospitals confront many difficulties that require special needs and among which, indicate the comforting needs, which may be either physical, psycho spiritual, social or environmental. Their behavior keeps on changing based on the above mentioned and hence behavioral tracking of children in the different spaces of the pediatric settings helps investigate the associations between the spaces and their attributes with the comforting of its user, suggesting design guidelines from the behavioral perspective which when placed can result in effective responses and interactions.

2.3

H O S P I T A L, C I T Y Hospitals reflect life. Everyday, there are people from different ages, social classes and gender, coming in and out. Some are working, others visiting or even living for a certain period. Comparing hospitals and cities since both aim to construct a living society comprising social, cultural, and economic integration.

A N D S O C I E T Y

2.3

H O S P I T A L, C I T Y A N D S O C I E T Y

Constructing a hospital may, therefore, be referred to as building a ‘city within a city’ , where a hospital is seen as a city with its own interior complexity, while it does not cease to be a constituent element of the city. Independently of being a general or a specialised hospital or even a clinic, it will relate with the city in terms of location, scale and accessibility, affecting people’s lives. It is part of the designer’s role trying to bridge the gap between the medical world and everyday life. However, the integration of the hospital in the city needs to respect the city’s identity.

The recognition of the increased trend of small residentialist patient care and smallscaled critical care centres has altered the space needed for overnight purposes and facilitates the division into clinics spread all over the city. Although large medical school hospitals’ existence will need to continue as it’s a body of service that can’t be separated from the city’s system.

2.3.1

The Council of Europe (2011) defined childfriendly health care as a ‘health care policy and practice that are centred on children’s rights, needs, characteristics, assets and evolving capacities, taking into account their own opinion’.5 This concept states that besides the high medical quality that should be guaranteed, children should have the right not only to be informed, according to their age group, consulted and heard, but also to not be separated from their family. Family-friendly health care is considered an included notion.

Besides hospital medicinal purposes, hospitals seem to incorporate social responsibilities with its users, allowing them to be active citizens rather than solely sick ones. A will to bring important aspects of outside daily-life to the hospital which can be noticed through the design of non-medical functions. Hospitalisation should provide ways to allow a regular development and growth through the integration of a homely environment and access to educational, social and entertainment facilities. A respectful environment which boosts their morale and surely helps improve the healing process.

https://rm.coe.int/168046ccef

H O S P I T A L

E N V I R O N M E N T S

2.3.2

I N F L U E N C I N G F A C T O R S

In order to achieve the best possible outcome which can serve as an accepted guideline for generating good outcomes, sensitively chosen influencing factors and design implications can have profound repercussions in children’s lives. Existing spaces manipulated by certain design strategies can benefit its users while creating goodwill for the hospital itself.

SENSE OF CONTROL ‘Experiencing uncontrollable events can lead to an expectation that one cannot control future outcomes’ -Seligman

In general, hospitals have established routines and rules that may lead to patients’ helplessness. Lack of privacy, poor wayfinding, physical barriers and poor communication are among the aspects that intensify the feeling of lack of control. An effective way to combat it is to provide patients with choices. The experience of losing control is almost related with every aspect of living in the hospital, such as disability to decide what or when to eat, or even the visitation hours. For a better balance, the ‘self-supporting systems’ approach, enabling an increase of control through the design of physical settings. One example can be enabling room changes, such as position of the bed, the degree of natural light or sound volume (television, music).

‘The process of reaching a destination, whether in a familiar or unfamiliar environment’ -Arthur and Passini

Children’s Hospital Boston

One of the aspects that influence the sense of control is Wayfinding. It is considered as a ‘spatial problem solving’. A mental image of the place layout is required for a spatial orientation. Understanding the actual location, the destination location, the route to choose, to follow that route or when the destination is reached, are part of the problem-solving process. In regard to children, their perception and navigation through space is different from adults, thus children’s hospital needs to provide solutions for a wide range of ages.

The use of clinical terminology seems confusing to children, but the use of colours to differentiate areas seems suitable for all ages. Other examples are the use of mosaics, floor markers, signs or even artwork as landmarks, which can be associated as reference points. It helps to provide a calming distraction, and also act as navigational landmarks.

‘An interpersonal boundary process in which a person or group regulates interaction with others’ -Altman

Nelson Mandela Children’s Hospital

Privacy is another factor closely related with control. This ability to control interactions can be considered even more important than the proper social interaction since it enables the controlled access to personal space or to the groups to which one belongs. Both privacy and socialisation are important factors if balanced in an effective way can offer a better hospital environment.

Personalization attributes children the possibility to manipulate their environment, being an important element of control. Personalization is an appreciated aspect of hospitals’ capacity of adaptability and flexibility. The possibility to establish their identity and appropriate level of comfort is what brings the opportunity of self-expression.

Privacy

Wayfinding

Sense of control

Personalisation

SOCIAL SUPPORT ‘in infancy the loneliness involved in separation may be not only undesirable but lethal’ -Horst and Veer

Children in their early age are extremely affected by social support and parental care. Their lack of knowledge about the world leads them to create expectations on surrounding people, whom they trust to be available and to give good social support, helping them to face any problem that may arise. They should socialise not only with the people on whom they are directly dependent, but also with other children and adults around them. When interacting with other children, they learn social skills, such as getting friends’ attention or asking to share something or only say something nice. In case of hospitalisation, it is important for a good development and to avoid isolation and rejection. Social support can reduce stress in populations belonging to diverse age groups. Thus, spaces for this purpose if made available can enable opportunities of socialisation for each age group resulting in a positive distraction from their hospital routine. Socialization spaces

Meeting moments

Social support

Family spots

POSITIVE DISTRACTIONS ‘Second to the continuing presence of the mother or another supporting figure, play can be an important factor in diminishing the harmful effects of stress in hospitalised children.’ -MacCarthy

Positive distraction in pediatrics is influenced by many factors which demonstrate positive influence on patients undergoing treatment or procedure. A healthcare environment provide a series of health benefits for patients, including improved behavioral and emotional well-being, reduced stress and anxiety, enhanced healthcare experience and satisfaction, and facilitated medical procedures and recovery.

Play

Education

Social support

Art

Nature

Royal London hospital

Playing is an important part of children’s life. It not only provides enjoyment, but also leads to an interaction and exploration of the environment. This positive activity develops children’s social, intellectual, physical and emotional growth. Furthermore, in a specific hospital environment, playing contributes to a decrease of stress and anxiety, and also helps to cope with the hospital admission process.

The change from a calm, recognizable place as home, to a busy and huge space with a lot of strange machines and different smells, noises, and faces can be terrifying. A social friendly space can help at this level, improving children’s understanding and interpretation of hospital language, sights and sounds.

Enjoyment Benefits of play

Design Guidelines

Enhance interaction & exploration Improved children understanding and interpretation of hospital

Playrooms and play areas with toys and games Play spaces within bedrooms

Inspiratiebeeld School

Education represents a fundamental activity in children’s development. In case of chronic illness, children have to stay long periods in hospital, so education programs were created for them to continue following the lecture contents corresponding to their age. Continuation of this activity seems to be of extreme importance, developing psychosocial well-being, and positive distraction from illness.

Psyco-social well-being Benefits of education

Distraction from illness Keeps patients busy with skill build up, achieving milestones

Equiped material for activities Design Guidelines

Classrooms setups

Seattle Children’s Hospital

Paediatric units offer a wider range of social activities than the general hospital, where adults suffer much higher levels of isolation. Art is another considered positive distraction in healthcare settings, which impacts stress and mood improvement for all categories of people present in the space.

A positive distraction Patient relation with art

Design Guidelines

Possible therapeutic effects Preference of nature images for calmness

Providing different mediums of art form

Crown sky garden

Nature is also a positive distraction which has proven to be known for health benefits like reducing stress levels and other health related complaints. Children are an age group particularly affected by the contact with nature and hospital provision of gardens,etc. The stress of hospitalisation can be reduced by offering a space less complex than hospital, with a more relaxing and familiar atmosphere, acting as a refuge.

Children are aware of functional aspects, i.e., about the active use of the space and respective exploration. They normally look after elements to climb, jump over, throw or even places to hide, where they cannot be seen but they can look out.

Reduce stress levels Health impact

Reduce health related complains Reduce pain medication Decrease hospitalisation period

Play games Potential Activities

Sports Rehabilitation exercise Sitting outside Play games Napping / meditation / prayer Walking or viewing Eating/ reading / doing work

SENSORIAL DIMENSIONS ‘The human senses are active perceptual systems, which can function independently or in combination, interacting with the surrounding environment to extract information -Gibson

Among all the senses, children are especially sensitive to the sense of touch, since it is the first sense being developed. It allows them to identify the proximity from objects and perceive movement. Through this sense children are able to explore materials, items and food, helping in their understanding of the surroundings. In designing facilities from this age group, different textures induce tactile exploration. Along with this, vision and acoustics are elements of privilege. A customized combination of daylight and artificial lighting along with sound can create an exception of experiences for the person in it. This is also combined with Color can create a huge impact in healthcare settings.It improves satisfaction of children and their families and sometimes help calm them too Light

Color

Senses

Noise

2.3.3

User participation is of an essence, especially when it comes to children. Their thinking process is way different from adults, their involvement in the decision making process can help make unique decisions and experience for any condition. This allows an easy identification of building problems and possible solutions while designing these environments. In this way, children and young people can influence the physical shape of spaces and create a positive impact on services’ quality, promoting ‘user-friendly’ buildings.6 However, the main challenge is not to give children an adult task, but instead, give them the opportunity to show their concerns and express their views.

Moreover, it is necessary to understand that children have different levels of competence diverging with their age, but all of them are able to tell what they like or dislike. The appropriate support and adequate information can allow them to express themselves through meaningful ways. Participatory design can help better identify the different possibilities of integrating children.

https://link.springer.com/referenceworkentry/10.1007/978-981-4585-90-3_33-1

E N G A G I N G

W I T H U S E R S

DECODING ELEMENTS

“A whole-of-society approach to health and well-being centered on the needs and preferences of individuals, families, and communities.” -WHO

3.1

B E I N G U P

The COVID-19 pandemic has turned the whole health care system upside down and challenged consumers’ sense of wellbeing. Being at home in fear of contact has surely changed lives in dramatic and unprecedented ways. It has made people question more and more on the model of life and self development. In many ways, consumers are taking charge of their health more than ever before. Taking and understanding precautions to keep themselves safe, even out of necessity, this pandemic accelerates change which will last on a long term in people’s mind and help strategize better for the foreseeable future.

Across the world, as the COVID numbers began to rise, medical facilities started to flood creating tremendous pressure on utilizing “space” to buckle under extraordinary circumstances. With massive influx of long term intensive care patients and limited number of bed accomodations and other facilities, the need for flexibility raised within them in order to have the ability to over-stretch. This led to questioning the conventional design strategies adopted by the country’s healthcare system and to completely rethink the way hospitals are designed. 7 Design and physical space plays a role in enabling disease to spread. Hospitals, being a hotspot of COVID patients, needed immediate changes in strategy to restrict the spread of infection and to prepare for the next wave.

http://emag.archiexpo.com/the-pandemic-effect-covid-19-reshapes-the-future-of-hospital-design/

T O D A T E

J O U R N E Y F R O M U N K N O W N

3.2

CASE STUDY 1

BLYTHEDALE CHILDREN’S HOSPITAL Location - New York Designer - Gwathmey Siegel Kaufman Architects Year - Founded in 1968, renovated in 2011 Hospital type - Private Area - 56,000 square-foot inpatient Hospital • Furniture & MaterialsUsed color, shape, materials, and landscape design elements to integrate this building into its site and neighborhood. • Positive distractionPresence of nature, Colorful art • Sustainability- Project included a major overhaul of all mechanical/electrical infrastructure, improving operations and efficiency throughout the existing building and into the new areas. - Replacement with new energy-efficient equipment serving the entire footprint • TechnologyUpdated tech systems with renovations • User experiencemedical and other services 24/7 to increase user comfort.

• Design strategies- Curved patient room pods break down the large mass of the building façade into scalable elements not much larger than the adjacent homes, and create a symbiotic relationship with pre-existing campus buildings. - The new patient rooms provide dedicated space for family members to stay overnight, and are oversized to accommodate varying rehabilitative equipment. - Creation of variable-acuity patient rooms that are designed to be exactly the same, reducing the need to move patients around and increasing flexibility in room assignments. - Staff work areas are located immediately outside of each patient room with visual access into each room, reducing travel distances for staff. • Changes because of COVIDClinicians and staff stepped up during the evolving crisis to utilize technology for medically complex patients in order to maintain their health and safety while their bodies healed.

Treating Patients with Varying Diagnoses and Needs

Comprehensive Care

Sustainability

Located in Residential Area

CASE STUDY 2

VIKRAM HOSPITAL Location - Bangalore Designer - ZZ Architects Year - 2010 Hospital type - Private Area - approx. 1,50,000 sq ft. • Circulation- The concept of signage (ECG Graph)was to merge it with the building elevations. - Each floor is color coded and the interiors reflect this in the smallest detail. • Furniture & Materials- Correct type of glass is used to reduce the heat and glare within the hospital. - Color, shape and materials in indoor are chosen to bring harmony • Positive distractionEmphasis is given on creating green walls and plantation in the surroundings • SustainabilityPaperless system of working • User experiencepaperless hospital in India which helps people connect with its surrounding more

• Design strategies- Designed with the theme which is inspired by the ECG HEART LINE GRAPH and so called “HEART BEATS THAT CONNECT” - Theme revolves around natural healing - The façade of the hospital is designed to catch one’s attention even from a distance. - A vertical garden is integrated with the compound wall. • Technology- Jaotech screen is also used by the patient for video conferencing with their relatives as well as the doctors - Latest technology to the introduction of graphic visual elements • Changes because of COVIDOnline communication systems (Tele and visual consultations)

Theme revolves around natural healing

Efficient Way-finding system

Sustainability

Technology savvy

CASE STUDY 3

FLORIDA HOSPITAL FOR CHILDREN Location - Orlando, Florida Designer - Trent Kahute & Philip Designs. Year - 2007 Hospital type - Private Area- approx. 1,15,000 sq ft • CirculationAquatic theme based design helping in navigation • Furniture & Materials- Centralized recessed storage areas - The product’s surfaces and storage areas are fabricated of Kydex, a durable thermoformable plastic alloy. • Sensory dimensions- Gave control of the room experience back to patients with ambient light and sound technology designed to help kids feel less anxious • Positive distraction- Intervention in pediatric x-ray rooms influenced patient distress behaviors, satisfaction, mood, and x-ray scanning time. - Interactive illusions in transitional spaces • SustainabilityUse of green energy resources

• Design strategies- 360-degree monitoring stations for nurses - Redesigned floor plans were human-centered, giving families a comfortable place close by without putting them between physicians and patients. • Technology- Installed a family scrub alcove at the entrance to the facility - Interactive installations • User experienceUse of user centric Experiential design Family dedicated spaces present • Changes because of COVID- New waiting room protocols - Anti-infectant materials

Experiencial design from human-centered perspective

Speical focus on service programming

Operational efficiency

Technology savvy

3.3

T H E K N O W N

CASE STUDY 4

DULAAR HOSPITAL Location - Bhopal Designer/Architect - Dimensions, Bhopal Year - 2013 Hospital type - Semi-Private • CirculationProper signages on walls • Furniture & MaterialsNo child friendly materials used Vinyl furnishings and storage • Positive distraction- Plantations - Use of attractive color in waiting areas • SustainabilityUse of solar energy in the building

• Design strategies- Maximizing space allotment in busy zones - Less blockage of views - Dedicated separate spaces for surgery and inpatient department • Technology- Advanced sanitization systems - Virtual communication accessible • User experience- Circulation is easy - Direct vantage towards all areas present • Changes because of COVID- New waiting room protocols - Adoption of prevention policies

Easy reachability to users

Focus on clinical programming

Operational efficiency

Upgratation of technology in medical terms

CASE STUDY 5

SWAMI VIVEKANANDAND SPINE CENTRE Location - Bhopal Designer/Architect Year - 2006 Hospital type - Government • Circulation- Proper signages on walls - Clear vantage points and directions - Ramps and bars on walls for better accessibility • Furniture & Materials- No child friendly materials used • Positive distraction- Plantations - Use of colorful paintings and wall hangings in wall surfaces • Technology- No technology used in space

• Design strategies- Open and large waiting area helps people to calm - Zones for waiting and other communicative areas are kept separate from the surgical and consultation floor. - Multiple access to floors eases smooth transitioning and reduces concentration of people in ane particular area. • User experience- Proper sinages help people get familar with space much easily - Artwork on walls helps interaction within the people waiting. - Use of white on most walls helps make the place look more spacious • Changes because of COVID- New waiting room protocols - Adoption of prevention policies - Demarkations with tape on furnitures

Easy reachability to users

Focus on zonal programming

Operational efficiency

Opportunity for bringing technology in space

2.4

L E T T E R

F R O M E D I T O R

“COVID-19 has brought into sharp focus all the existing structural, organizational and technological challenges associated with old and obsolete healthcare facilities” “The pandemic has shown us that we need to halt the industrialization of healthcare spaces and humanize them instead.” - Filippo Taidelli

The COVID-19 pandemic has turned the whole health care system upside down and challenged consumers’ sense of well-being. Being at home in fear of contact has surely changed lives in dramatic and unprecedented ways. It has made people question more and more on the model of life and self development. In many ways, consumers are taking charge of their health more than ever before. Taking and understanding precautions to keep themselves safe, even out of necessity, this pandemic accelerates change which will last on a long term in people’s mind and help strategize better for the foreseable future.

The building boom among children’s hospitals is evident and has no end in sight. It is common today for hospitals to face pressure to renovate, upgrade, expand, and enhance facilities if they are to remain competitive in this increasingly consumerdriven industry. 8 Quality of care data and patient satisfaction scores are made public with widespread availability, creating pressures from payers, employees and community members for accountability and hence focusing attention towards improving results. COVID-19 diverted this perception and now it’s a challenge to focus on all at once. Intentionally designed experiences throughout the continuum of pediatric care can range based on different age groups, from infant to child to adolescent. The design of the patient care units must meet the needs of all ages. Incorporation of the child life services in support of education, play and activity is essential. Child life requires dedicated space, which can be as minimal as unit-based storage or as robust as centralized, multi-purpose activity and/ or classroom spaces. 9

https://faros.hsjdbcn.org/adjuntos/162.1-CurrentTrendsInPedHospDesign.pdf https://www.hdrinc.com/insights/design-strategies-pediatric-spaces 9

SOLVING THE RIDDLE

Play is the real work of childhood - Mr. Rogers

4.1

A healing environment can be defined as a holistic environment that facilitates patient rehabilitation. Such an environment offers a variety of influencing factors to form what we know today as ‘a hospital’. A physical environment of which can be divided into two categories: indoor and outdoor environments, which helps increase interactions between children and the society.

A Health Unit space type should provide a sanitary and therapeutic environment in which patients can be treated by medical practitioners quickly and effectively. A clinic’s size and configuration are determined by its specialization and location. The unit space type can be configured into a number of different types of modules to accommodate many approaches to design. Based on upcoming trends, these individual units tend to move towards a wider collaborative approach , which requires for example, nurses’ stations and physicians’ offices to be close to each other (or eliminate private offices altogether) to provide shared work areas and more opportunities for communication. A clinic/health unit setting is intended to also serve as a healing environment. So there is also a trend to design less clinical-looking spaces, and introducing more of a personal or homey feeling in individual patient rooms and admitting areas. Access to nature and the colors of nature also support healing. So design the space holistically by incorporating the colors or scenes of nature when views to nature are not available or possible. 10

Typical features of healthcare unit space include:

Accessiblity

Aesthetics

Operational

Productive

Safety

L O O K I N G A T

W H A T’ S E X I S T I N G

Sustainability

https://www.wbdg.org/space-types/clinic-health-unit

45-60

30-60 mins

Depending on arrival time

Check in

Assessment

Treat

Resus Peop life thr illn inj Ambulance

Major People w urgent inju

Doing

Handover

Treated in order of urgency

Nature of Communication

Feeling

walk in

Check in Appointment schedule

Assessment Initial Examination

Minor Peop less u illne inju

Uncertain Concerned

Rushed Anxious

Stre Emo

Provision of basic Information

Expressing concern

Excha infor

Listin instru

0 mins

15-20 mins

tment

Outcome

scitation ple with reatning ness or juries Hospital People needing further treatment

r Injuries with very illness or uries

r Injuries ple with urgent ess or uries

Depending on treatment

Admission

Stay for treatment Discharge ICU OR ER

Waiting till process of test results and treatment decision

Leave ED Most people will leave ED after treatment

eesed otional

Concerned Frustrated

Tired Scared

ange of mation & ning to uctions

Listining to procedures

Explaining and following treatment

Relieved

Follow up

EXISTING PROGRAMS

Private ward

Transiti

Family lounge

Activity area

Educational activity room

Common spaces

General ward

Semiprivate ward

PEDIA HOSP ICU

Wai are

Washrooms

Sanitization area

“As healthcare institutions are under increas compassionate care settings, there is no better tim designers to improve the care model by

Office space

Staff rooms

ional

Doctor’s Lounge

Daycare Activity area

ARD

Nursing room

ATRIC PITALS OPD

Counselling Exam rooms

iting eas Outdoor spaces

Storage

sed pressure to improve efficiency of care in me for health practitioners to link with healthcare y finding the evidence for what works.”

Reception

4.2

W H Y

“The world demands the quality of youth; not a time of life but a state of mind, a temper of the will, a quality of the imagination, a predominance of courage over timidity, of the appetite for adventure over the life of ease” -Robert F. Kennedy

C O N V E N T I O N A L

In a hospital, two types of failures can compromise patient health and safety and even result in serious injury or death: active failures and latent failures. An active failure is a human error—a mistake made by staff. A latent failure, on the other hand, is a flaw in the procedure itself or in the building’s design that results in patient harm. 11 That is where a designer’s job comes into the picture. The design of a facility/structure with its fixed and moveable elements can have a significant impact on human performance. Physical environment, the patient itself and the staff outcome are all linked. Traditional systems emphasize the need for standardization, simplification, and use of protocols and checklists to improve health care outcomes. Basic questions such as environmental, physical, mental and spiritual health and wellbeing are often overlooked in the rush to design health and hospital facilities.

Quality

S Y S T E M S F A I L E D?

Communit

Access

CHALLENGES

Home and family structure

Demographics

Alignment of care and expertise

https://hmcarchitects.com/news/hospital-interior-design-trends-to-reduce-active-and-latent-failures-2019-02-01/ https://www.asianhhm.com/facilities-operations/issues-trends-hospital-planning-design 12 11

Sustainability

Patient safety

“

A key determinant of things that matters when it comes to health interventions — the experience, cost, and results. It is the buildings and spaces in which patients are treated. The size and layout of a room, whether a bed sits in the middle or against a wall (even which wall), how much space is maintained for patients to walk versus how many beds or operating equipment can be accommodated, have not been considered predictors of health outcomes in the past. User experience in a build environment was considered secondary and hence hindering the updation process of healthcare facilities.

“Since the beginning of the industrial age, we have preferred to abandon what is old or outdated, weather things or people. The paradigm is not changing, giving way to maturity, neither young nor aged, new nor old, what is emerging is a respect and understanding for what has gone before - maturity entails the acquisition of a wisdom that transcends the either -or- stereotypes.” -Miller RL

4.3

DESIGN ENGAGEMENT

I M P R O V I S A T I O N

Positive distractions can engage families and patients at all levels. Providing space for patients and visitors, including ageappropriate diversion activities such as interactive multi-touch walls, playrooms for young patients and high-tech gathering spaces for teenagers. Crafting an architectural language that children and adults can understand. Using form, materials, color and texture to develop places in which patients and their families feel a sense of belongingness and a more home-like atmosphere.

Mary Bridge Children’s Hospital

CREATING NEIGHBOURHOODS

Pediatric patients have different social and privacy needs than adults and the organization of this unit responds to accordingly. The linear “hospital” layout of adult inpatient units lacks the environmental stimulation which is important to a developing child. 13 Pediatric inpatient units that are organized around neighborhoods with their own identity and emotionally accessible parameters help to break down the scale of the unit — this reduces stress in patients, families and caregivers as they focus their energies on “living” in a more appropriately sized space.

Connie Maynard Children’s Hospital, North Carolina 13

https://www.hfmmagazine.com/articles/3328-four-key-design-strategies

FAMILY MINDED It’s improtant to think of family members’ role as caregivers. Emphasizing space for families including family sleep rooms, kitchens, extra storage and other spaces that allow families to continue familiar and comforting routines for a child. Providing technology so families can connect with work, home, school and classroom spaces that gives children the opportunity to continue their education throughout the treatment process.

Children’s Hospital & Medical Center, Nebraska

INTEGRATING FLEXIBILITY

Provision of added convenience for families by incorporating interactive play areas for siblings and flexible exam rooms that accommodate families. Design patient rooms to be acuity adaptable to minimize the need for moving patients and causing disruption to families. Spaces can be designed to be expanded and have flexibility as changes to the delivery of healthcare changes with new technologies and advancements.

HEALING ENVIRONMENTS Considering daylighting, noise control and acoustics, air quality, privacy, social support and positive distractions in designing a healing environment. Separate treatment areas from patient spaces to keep the patient room a safe haven. Considering patients with special needs, including children with autism, and provide low-stimulation healing environments. Taking healing outside. Children need access to outdoor therapy spaces that are playful and healing, calming and rejuvenating. Outdoor healing environments such as healing gardens and activity spaces create opportunities for improved indoor/outdoor connections that minimize stress for children and families — let kids be kids, even in a healthcare setting. Benioff Children’s Hospital Oakland

SOCIAL NETWORKING Children approach and interact with their social networks in ways never before possible, which means creating a world where being in the hospital does not mean children are separated from their circle of friends. Incorporating technology so that schools and social networks are brought into the room in full of living color, allowing participation and fostering social identity. These networks will demand a physical presence as the hospital becomes social space, transforming a once clinical area into a community center. Areas on the unit should be able to host birthday parties, play dates, study sessions and group activities that are part of everyday life.

CAREGIVER’S SUPPORT Recognizing the demands patients and their familes place on caregivers, acknowledging the emotional investment they make every day and providing them areas for respite and recharge with natural light and consideration of circadian rhythms.

Design of units to allow nurses more time at the bedside, greater visibility throughout the unit, and quick and easy access to medication and supplies. Create highly collaborative environments to provide opportunities to enhance the knowledge transfer process among clinicians and patients, and, if appropriate, scientists.

St. Mungo’s Hospital

C O N S I D E R I N G H E A LT H I M PAC T Multidisciplinary space is also needed to support programs that draw in community organizations, religious leaders, educators, police and safety groups. Activities for these groups can include personal or group religious services, classes on the dangers of alcohol and substance abuse among adolescents and teens, educational sessions on mental and behavioral health services to raise awareness. College admissions counselors can host interviews with prospective applicants and emergency response personnel can expand their educational reach through dialogues on public safety. Health organizations that create space and opportunities for these types of activities can find greater success in their population health initiatives and reinforce the integration of health into “normal” life for their patients and families. London Children’s Hospital

4.4

P R O P O S E D

M O D U L E

WARD CONFIGURATIONS Ergonomic furniture

Efficiency of space

Clinical support facilities

Maintaining privacy

Biophilic elements

Easy access

RECREATIONAL SPACES Sensorial effect Air quality check Common space for all

EDUCATIONAL SPACES Signage and displays Multi-purpose space for engagements Variety of seating patterns and configurations

WAITING + PLAY Long vantage points Technological driven update Artistic elements

DAYCARE Child friendly materials Equal importance to ratio of children to staff Away from busy area

NURSE’S STATION Maximum vantage points Easy accessibility 360 degree viewpoint

RECEPTION Easy way-finding system Interactive with art Children’s ergonomics

DRIVE - THRU Smaller clinic setip Safer way of approach

4.5

D E S I G N B R I E F

A ‘Pediatric or Children’s hospital’ is a space which offers its services exclusively to children and adolescents. In this case, the hospital’s approach towards design becomes important because children are in a singular condition of learning and interacting with the world around, requiring specific activities for a normal development. It’s quite important to marry the ‘Visual perception’ to the ‘complex functionalities’ of the hospital’s already set program. Age group, underlying condition or problem which does not allow them to have their childhood. This creates an environment that looks at palliative care for the patients. The quantity and quality of environment both have an effect on the behaviour on the patient as well as the caregiver. A children’s hospital must have a different approach towards caring about its users and not just providing curative treatment to them. Indian conventional practises do not support the psychological outcomes of its users especially in a semi-urban context where provision of healthcare is limited. Small cities look up to the developed ones to fulfill their need of satisfaction of overall serviced outcomes.

The need for change in this particular context is proposed in ‘Chirayu medical college and Hospital, Bhopal’. A renowned multispeciality government hospital which started its journey with medicine and pediatrics in 1992 and has been in the race of growth since then. The location comes with a great set of design opportunities like ample space allocation, widespread presence of biophilic elements and more along with scope for development in order to enhance the end user satisfaction. The aim is to explore the role of interiors with a multi-disciplinary approach in creating not only a therapeutic hospital environment for children but also an environment that provides them to connect with the outside and have as much as possible normal patterns of life. Addressing the various healthcare systems along with providing a comfortable environment for both the patients in primary but also the other caregivers involved in the process.

Designing for young patients means designing spaces that inspire confidence, encourage playfulness, and offer hope. Implementing various spatial, educational and technological strategies and systems help improve efficiency of the current structure. Whereas, Influencing design with sense of control, social support, positive distraction, sensorial dimensions, age differentiation and security helps improve connection of space and its users. Pandemic has caused enormous disruptions in the working of these structures, with improvising the traditional methods through modern variations, the design hopes to cope up with those challenges. Inspiration of conceptual planning comes from mat building concepts for a solid platform for circulations within zones creating sensitive ‘trafficflow’ within the facility, while looking at multiple ward unit configurations to reduce the risk of adverse clinical errors and infections, allowing privacy, and providing flexibility with the potential for increased capacity.

The proposal also looks at bringing about ancillary programs of wellbeing such as • Pet visitation therapies • Clinical learning • Academic skill buildup spaces to promote positive reinforcement or distraction whatever the case maybe and help maintain the normal development patterns of life for the in-patients. The idea of distraction is more about creating a relaxing, non-aversive response the moment a child arrives with their families, maximizing the availability of age-appropriate experiences and activities. Caregivers’ spaces are equally important than those of the patients, the common denominator of family-centric design is comfort and familiarity. The design also proposes to intervene in Spaces like family consultation rooms, prayer room, sleeping pods, kitchenettes, therapy rooms and more which nurtures the vital adult-provider relationship on behalf of pediatric patients and reduces the stress for a safer and predictable outcome. It can also assist short and long-term patient families with remote working, schooling, or other routine functions.

The Big picture An exceptional patient experience for children and families begins with a kid-centric mindset and intentionally designed environment which helps reduce patient/family/caregiver’s anxiety and enhance their relaxation through age-appropriate design features and planned distractions. Recognizing how the supporting environment benefits the augmented typology of Pediatric design convinces adaptation of this module to various other facilities that can encourage a community based approach towards improving the quality of care through spatial settings.

COMPLETING THE PUZZLE

Why does Location matter?

There are numerous factors that influence the provision of hospitals and their ability to provide equitable access to care services. One of the prominent factors amongst them is the location. In a country like India, it’s especially important as a significant bulk of the population resides in the rural and remote areas where access to healthcare is minimal. Access to Pediatric facilities is much less in rural areas as compared to urban, even though the overall Infant Mortality Rate (IMR) has decreased.In Rural areas it is 1.5 times the rate in Urban areas. There are contrasting differences in the accessibility, quality and utility of care services rendered between the urban and rural residents. IMPACTS

Cost control

Greater Visibility

Better patient satisfaction Scalability

Spectrum of services Impact on community

Ease of patient access

https://www.frontenders.in/blog/impact-of-hospital-location.html

5.1

S I T E

A N A L Y S I S

C H I R AY U M E D I C A L C O L L E G E A N D H O S P I TA L

Bhopal, MP A renowned multi-speciality government teaching hospital at the outskirts of Bhopal, whose aim is to develop strategic plans in order to reach it’s expansion and delivery of services. Chirayu-in original Sanskrit expression conveys the universal human desire for longevity. Its journey with medicine and pediatrics started in 1992, it has been in the race of growth since then. It’s the first hospital in MP to discharge 1,000 patients who suffered COVID-19. The site location plays an important role in this situation, it attracts people in and around Bhopal but access to space on a city level has been considered distant. Development is the key to enhance the end user satisfaction and the site has extensive potential for it.

Attracts Medical Tourism

North facing orientation & SW Wind Patterns

Internal courtyard typology adapted

Extreme Temperature

Main Entrance

Parking

In patient Department Entrance

Waiting area (outside)

Strength

Opportunities

- Large space developed and expanding - Lots of greenery in surroundings - Clear circulation outside - Spacious for existing programs

- Exploring climate sensitive materials and in this case child friendly too - Exploration of attractive and playful elements in the facility

Weakness

Treats

- Poor circulation and way-finding - Access to site is difficult in terms of travel - Sun blocking because of the built architecture, only the exterior parts of the hospital could get natural light.

- Security - Uncleanliness in transitional spaces

Hospital Area Green areas Circulation Neighbouring areas Road Railway Tracks

MACRO

Chirayu Hospital

MICRO

nce

ra Ent

N 81

5.2

D I G G I N G D E E P

Hospital building

Cafeteria

Entrance

Parking

SITE CIRCULATION

Second floor WARDS

Ground floor OPD

ICU

Roadway circulation

WARD

Approx 10,000 Sq. Ft. 6

3,250 S 1

5 4

3 9

4 8 7

DOWN

Second Floor

Ground Floor

RAMP

EXISTING

3 9

7 4

14 13 15

PICU & ROOMS

4,570 Sq. Ft.

Washroom

Doctor’s Lounge

Private rooms

Play room

General ward

Demo room

Waiting area

Immunization

Buffer area

Nurse’s Station

Semi-Private room

Storage

Janitor’s closet Consultation

Sanitization

Daycare

Lab

Mother’s room

Examination room

Family room

Treatment room

PICU

Reception Circulation

Educational area

ZONING

Sq. Ft.

20 21

PROPOSED

15 20

Second Floor

DOWN

RAMP

Ground Floor

1 11

5.3

P R O G R A M S A N D

I am scared to go inside just for a small thing...

My child is so sad is missing school, i could do somethi about it...

Reception I am so confused... Which direction should i go?

Waiting

C H A L L E N G E S

Activity area Lift

Transition Corridor Where should i go next?

Paperwork of Patient ...

OPD There are so many doctors here? I am worried

Discharge I don’t want to leave my child with others during COVID times

Transition

More patients Heavy circulation Which form to fill?

Waiting Play

Consult Staff

Mama, I don’t like this place. I want to play with my toys!!!

Wards

that he wish ing

INPATIENT FACILITY

Why can’t i keep an eye on every patient at one time?

Treatment rooms

EXIT Discharge Laboratory

Waiting area

Storage

I wish we get some privacy while resting

ICU

I am so tried taking care of 2 children at a time without any help

HEALTHCARE PROFESSIONALS On call rooms Nurse’s station Offices

Ward

Recovery room Waiting

Isolation ward Nurse station

5.4

P L U G G I N G T H E

M O D U L E

Daycare

Playroom

ACTIVITY Educational

Patient FUNCTIONAL

con

Nurse station

Family USER Healthcare Professionals

DIRECTIONAL Way-finding

RECREATIONAL Waiting room

PROGRAM DEVELOPMENT

Ward nfiguration

Consultation

Color

Tech

Open spaces

The programs of the module are edited based on this hospital’s existing system and functional programs, location and other aspects. Keeping in mind the user interaction with the space, targeting specific areas can help improve the satisfaction in an individual’s journey. With the help of these design strategies, the primary user i.e the patient can feel welcomed and create a good impression in his/her mind about hospitals. The impact of these build strategies can create a lasting impact on these children psychologically, behaviorally and physically. This creates not only a correlation in space-healing progress but space-life progress, giving the children an opportunity to carry on with their lives, without an abrupt change and interruption. This Pediatric unit provides high-quality, high-tech care in an inspirational and safe environment. The design influences the overall environment from a patient, family and clinician point of view. The patients and families benefit from thoughtfully designed interior elements created for the specific pediatric population. Clinicians in these environments should have appropriate workspace for clinical care, charting and collaboration with individual spaces and others with design elements that benefit all.

LOOKING AT THE CANVAS

6.1

M O O D B O A R D

Each space is designed based on a theme and color scheme which will ultimately be contributing to the wayfinding systems for the patients and their family. The variety of colors react to neurological and physical levels, affecting body, mind and emotions. Hospital’s approach towards color theory can matter a lot when considering children since then can be more sensitive to colors. Children need to be educated in areas that boost their creativity and imagination and a hospital environment can create an opportunity for the same.

Each element plays a role, from color, materials, textures to lighting and configurations. It all contributes to children’s learning milestone which is one of the major design strategy implementations of this module.

6.2

M A T E R I A L B O A R D

Play is familiar and reassuring. It’s how children make sense of the world around them. In hospital, it helps children to learn and develop, and to feel less anxious. It provides an opportunity for your child to make choices so that they can have a sense of some control. There will be toys, games, craftwork, books and other activities available. There will probably be a ‘medical kit’ for your child to play with. Playing with real or pretend medical equipment helps children become confident with things that are usually unfamiliar to them. This can lessen feelings of fear.

Selecting the right material and color is an important factor for each healthcare facility. A neutral base palette can be a unifying factor across the various interior spaces, from public to backof-house areas, and from patient treatment to staff work areas. People of all ages and abilities feel more comfortable when walking on firm ground with good traction. Different material options based on code of conduct is an essential part of healthcare design, adding to the safety of users as an advantage.

https://www.frontenders.in/blog/impact-of-hospital-location.html

6.3.1

F L O O R

PEDIATRIC WARD B

APPROX 10,000 (9965) Sq. Ft.

DOWN

A 5'-5"

Semi-private ward

Common washroom

Nurse's station

P L A N

10'

RAMP Storage

SECOND FLOOR

General ward

20'

C Storage

Reception

Lab

11'-4"

Daycare

Sanitization

Waiting

PICU & PRIVATE WARD 4570 Sq. Ft. PICU - 1100 Sq. Ft. PRIVATE WARD - 1000 Sq. Ft. Isolation ward

Disposal section

E' 42'

Examination room

Waiting

play area

GROUND FLOOR

Intitail Examination

Common Washroom

Reception

Mother's room

OPD

3250 Sq. Ft.

@ 1:350

6.3.2

S E C T I O N A L

DOWN

10'

RAMP SECOND FLOOR

11'-4"

E L E V A T I O N S

GROUND FLOOR

DOWN

10'

RAMP GROUND FLOOR

11'-4"

SECOND FLOOR

@ 1:350

6.3.2

S E C T I O N A L E L E V A T I O N S

DOWN

10'

RAMP GROUND FLOOR

SECOND FLOOR

11'-4"

@ 1:350

6.4

S E R V I C E D R A W I N G S

DOWN

RAMP SECOND FLOOR

42'

GROUND FLOOR

1 2 3 4 5 6 7 8 9 10

Directional lights Recessed light (5") Recessed light (6") Customized ceiling lamps Customized pendant light Customized pendant light Recessed ceiling running lights Wall hung lights Cove lights Recessed ceiling light rectangle

101

6.5

R E N D E R S

Reception area

Waiting area overseeing the play area

ICU ward room

Waiting area for family

103

6.5

R E N D E R S

Corridor

Educational space (front view)

Educational space (Perspective view)

105

6.5

R E N D E R S

Semi-Private ward

Waiting area - semi private ward

107

6.5

R E N D E R S

General ward

Waiting area - general ward

109

WHAT NEXT?

7.1

W H A T

When we are designing children’s hospitals, we tend to focus on how to make the medical environment seem more like home for young patients and their families. What has been less well considered, until now, is how we can use design to help children engage in their own treatments in subtle yet empowering ways. Clinicians tell that it can be difficult to prepare children for surgery and other medical procedures. They tend to rely largely on bedside conversations in the run up to treatment to gauge their young patients’ wellbeing and state of mind. Yet children often find it hard to express how they are feeling, particularly to adults they are unfamiliar with.

By implementation of the above strategies, design can help these young patients to engage and express. It can also drive comfort, while allowing them to have control of their environments. Integration of smart hospital in future by use of Medical electronic bands. These interfaces will enable them to control aspects of the environment around their hospital bed, such as lighting and temperature, and make requests for food, assistance or entertainment. This will act as a communication and knowledge points when it comes to medical point of view. A parent can access the right information with it and not get lost in the internet seaching for answers.

C H A N G E D ?

With that said, improving pediatric design with the help of this module can create a larger change socially and mentally for all its users.

111

Children are not only innocent and c and essentially happy. They are, in could - Carolyn

curious but also optimistic and joyful short, everything adults wish they d be. Haywood 113

7.3

B I B L I O G R A P H Y

JOURNALS 1. https://www.hopkinsmedicine.org/international/partners-forum/pastpresentations/2016/04_Boekemeyer_Slater_Mapping_the_Patient_ Experience_at_CLC.pdf 2. https://deloitte.wsj.com/cio/2020/09/17/how-the-pandemic-is-changing-health-care/ 3. https://www.hrpub.org/download/20191030/UJPH2-17612604.pdf 4. http://psrcentre.org/images/extraimages/12.%20ICECEBE%20113810.pdf 5. http://www.designcurial.com/news/focus-hospitals-5820490 6. https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/Strenghtening_ Facility_Based_Paediatric_Care-Operational_Guidelines.pdf 7. http://www.icdkwt.com/pdf/policiesandguidelines/DesignandConstruction/ GuidelinesforGeneralWardDesign-2008.pdf 8. https://isccm.org/pdf/Section1.pdf

REPORTS 1. https://www.rcpch.ac.uk/sites/default/files/2020-06/paed2040-post-covidreport-20200626.pdf 2. https://faros.hsjdbcn.org/adjuntos/162.1-CurrentTrendsInPedHospDesign.pdf 3. https://www.childrenshospitals.org/-/media/Files/CHA/Main/Quality_ and_Performance/behavioral_health/bh_focus_children_mental_health. pdf?la=en&hash=09D2BBC2068B7DA410D589F15C43BF40C4872BE

BOOKS 1. https://files.eric.ed.gov/fulltext/EJ1100787.pdf 2. https://www.lisc.org/media/filer_public/ef/02/ef02cf88-eef9-4091-9f96aa03f88931cb/2005_cick_guide_vol2_designing.pdf 3. http://www.wales.nhs.uk/sites3/Documents/254/WardlayoutsDiscuss.pdf 4. https://apps.who.int/iris/bitstream/handle/10665/272346/9789241565554-eng.pdf?ua=1

ARTICLES 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513658/#:~:text=Stakeholderdeveloped%20interventions%20are%20needed,)%20communication%20 and%20decision-making.&text=Stakeholders%20included%20parents%20of%20 PICU,HTMs)%2C%20and%20research%20experts 2. https://www.sciencedirect.com/science/article/pii/S153204641400269X 3. https://pursuit.unimelb.edu.au/articles/architecture-and-design-in-a-post-pandemic-world 4. http://emag.archiexpo.com/the-pandemic-effect-covid-19-reshapes-the-future-of-hospital-design/ 5. https://healthmanagement.org/c/healthmanagement/issuearticle/design-for-paediatric-health 6. https://learnwellservices.com/how-you-can-create-a-successful-hospital-education-program-forstudent-patients/ 7. https://www.designboom.com/architecture/inaba-williams-playful-pops-color-in-shigeru-ban-castiron-house-new-york-03-09-21/ 8. https://designlike.com/top-10-elements-of-a-perfect-hospital-design/ 9. https://www.researchgate.net/publication/280096058_How_to_design_child-friendly_hospital_ architecture_Young_patients_speaking 10. https://www.researchgate.net/publication/266673002_INNOVATIVE_MATERIALS_IN_ CHILDREN’S_HOSPITAL_DESIGN 11. https://www.healthcarefacilitiestoday.com/posts/Material-Health-in-Healthcare-Facilities--25210 12. https://www.researchgate.net/publication/233423987_Wall_Finish_Selection_in_Hospital_ Design_A_Survey_of_Facility_Managers 13. https://hhbc.in/pediatric-hospital-planning-designing/#:~:text=PICU%20Design%20and%20Bed%20 Area&text=Adequate%20lighting%2C%20child%20friendly%20wall,wash%20basin%20for%20 two%20beds 14. https://www.linkedin.com/pulse/icu-design-future-planning-designing-tarun-katiyar/ 15. https://www.worldarchitecturenews.com/article/1700268/africas-medical-prototype-receives-aia2020-healthcare-design-award 16. https://www.hksinc.com/what-we-do/case-studies/norton-womens-and-kosair-childrens-hospital/ 17. https://www.hospitaltimes.co.uk/healthcare-design-in-a-post-covid-19-world/ 18. https://bllighting.com/our-case-studies/childrens-hospital-orange-county-choc/

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WEBSITES 1. 2. 3. 4.

https://www.macadamian.com/learn/healthcare-customer-journey-mapping/ https://medium.com/sharing-by-mirco-pasqualini/a-post-pandemic-design-5a9b52603ae https://www.hdrinc.com/insights/design-strategies-pediatric-spaces https://www.healthline.com/health/childrens-health/stages-of-child-development#18months-2-years 5. https://www.ceregrow.in/child-nutrition/development-stages-milestones 6. http://www.sintex-mebel.ru/en/med/articles/rules1/ 7. https://www.google.com/url?q=https://www.seattlechildrens.org/clinics/school-services/&sa=D&source=editors&ust=1619281514207000&usg=AOvVaw3qbaz5D3WYVFrtepAmuSfD 8. https://www.bestmastersineducation.com/faq/do-pediatric-hospitals-need-teachers/ 9. https://learningspacesglobal.com/projects 10. https://www.architectural-review.com/essays/the-strategies-of-mat-building 11. http://www.studio-sc.com/seattle-childrens-hospital.php 12. https://pattersonpope.com/industries/healthcare-storage/#patient2floor 13. https://www.kidssoup.com/activity/doctor-preschool-activities-lessons-and-games 14. https://thinkplaycreate.org/explore/art-installations/ 15. https://www.bdcnetwork.com/blog/creating-child-friendly-healthcare-spaces-five-goalssuccess 16. https://www.worldarchitecturenews.com/article/1702247/architect-filippo-taidelli-assists-birth-emergency-hospital-19-concept 17. https://www.saramarberry.com/10-innovative-healthcare-design-ideas/ 18. https://thrivethinking.com/case-studies/florida-hospital-human-centered-design/ 19. https://www.hksinc.com/what-we-do/case-studies/taikang-tongji-international-hospital/ 20. https://www.archinomy.com/case-studies/vikram-hospital-bengaluru-india/ 21. https://www.archilovers.com/projects/79503/vikram-hospital.html 22. https://e4harchitecture.com/rehabilitation-design-case-study-blythedale-childrens-hospital/ 23. https://www.sheppardrobson.com/architecture/view/nelson-mandela-childrens-hospital 24. https://www.archdaily.com/932317/ekh-children-hospital-s-csb

MAGAZINES 1. https://healthcaredesignmagazine.com/trends/perspectives/reimaging-healthcare-design-after-covid-19/ 2. https://www.dmagazine.com/healthcare-business/2020/07/how-is-covid-19-impacting-healthcare-design/ 3. https://www.google.com/url?q=https://www.hfmmagazine.com/articles/1198-sign-language?dcrPath%3D%252Ftemplatedata%252FHF_Common%252FNewsArticle%252Fdata%252FHFM%252FWebExclusives%252F2011%252FWebExclusives_Signlanguage&sa=D&source=editors&ust=1619281346748000&usg=AOvVaw0JtNHkzdswwBIHj5XV7WzG 4. https://mcdmag.com/2018/02/child-ready-envisioning-pediatric-spaces-of-the-future/#. YIQ4mpAzZPb 5. https://www.hksinc.com/wp-content/uploads/2020/03/Singapore_Pandemic-Outbreak-Design-Solutions_2020-03-29.pdf 6. https://www.hfmmagazine.com/articles/1801-pediatric-facility-designs-embrace-family-and-fun

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