Thesis Research | Volume 1 by Reem

Designing for Children A Pediatric Ophthalmology Center in Kuwait

Thesis 2018 | Volume 1 Reem S. Bukhamseen 1

Contents 2-3

Statements

4-7

Site

8 - 13

Case Studies

14 - 15

Programming

16 - 23

Plan Prototypes

24 - 25

Colors and Materials

26 - 31

Codes

32 - 33

Thesis Focus

34 - 35

Goals and Objectives

36 - 45

Related Research

46 - 49

Sustainability

50 - 51

Works Sited

Problem Statement For my thesis project, I am designing a one story 39,420 sq.f Pediatric Ophthalmology Center to be affiliated with the neighboring Sheikh Jaber Al-Ahmad Al-Jaber Al-Sabah Hospital, which will specialize in treating pediatric eye diseases as well as provide future prevention. The design aims to progress healing and create satisfactory patient visits through ease of navigation, implementation of indoor garden spaces, and the consideration of the well-being of staff and patients. The research conducted for this project will demonstrate the importance of functional wayfinding, sustainable design, and patient/staff well-being within public pediatric facilities in Kuwait.

Thesis Statement Clear wayfinding in healthcare facilities provides patients, guests and staff a simple system of navigating through the hospital without additional stress when reaching a final destination. The usage of sustainable materials and practices in the facility will reduce overall facility maintenance and energy costs over the centerâ&#x20AC;&#x2122;s lifespan. Integration of indoor garden spaces, both visually and functionally accessible to all users of the facility, will increase staff productivity, progress healing, and enhance the patientâ&#x20AC;&#x2122;s experience. Implementation of specialized spaces that cater to the users well-being will provide satisfactory patient visits, boost staff interaction and health, and will leave the end user with a positive outlook on healthcare facilities in Kuwait.

Site Analysis Location: Al-Zahra, Kuwait. King Khalid Bin Abdul Aziz Street. Hottest Month: July (101 F avg) Coldest Month: January (56 F avg) Wettest Month: July (0.72â&#x20AC;? avg) Highest Temperature: 115 F Lowest Temperature: 45 F

Hospital Mapping

H HH

H H

H H HH

Indicates environment that contains healthcare facilities, including hospitals and polyclinics.

H H

Kuwait

H H

Environment Mapping Areas affected by the polluted Gulf, spreading discomforting odors throughout neighboring environments. Areas closest to Kuwait City, causing neighboring districts to be highly populated.

Kuwait

Areas in close proximity to oil extracting facilities, causing high levels of pollution.

Site Location Al-Zahra District Area: 5.41 km^2 Density: 5,337.9 /km^2 Specific Hospital Site

Kuwait

Site Analysis Nearby Facilities - Post Office - Coffee Shops - Petrol Station - Mosque - Bank - Sahara Golf Club - Murouj Complex - 360 Shopping Mall - Al-Zahra Coop - Jaber Al-Ahmad Al-Sabah Hospital - Public Park The Pediatric Ophthalmology Center will be affiliated with the Jaber Al-Ahmad Al-Sabah Hospital, which is a neighboring polyclinic hospital, opening itâ&#x20AC;&#x2122;s departments one facility at a time. The center will cater to patients redirected from the existing hospital facility.

Already existing park. Selected site for hospital.

Al-Zahra is considered a new housing district, as residents are still building new homes and government authorities are still implementing public parks and buildings. The center will be in close proximity to the most advanced public hospital in Kuwait. This allows the facility to continue to provide high standards of healthcare service, as it will serve all different classes of Kuwaiti citizens and residents. Potential space provided to account for building parking spaces and outdoor landscaping. The center will take the current location of the Public Authority for Housing Welfare building.

Culture + Demographics About Kuwait

Kuwait’s climate consists of a dry desert, hot summers, and short cool winters. Kuwait’s natural resources include petroleum, fish, shrimp, and natural gas. Though Kuwait is geographically small, it is wealthy. It has an open economy with crude oil reserves of about 102 billion barrels, which is more than 6% of the world’s reserves. With none of the population below poverty, the unemployment rate is also low, with a total of 3%. Kuwait’s main industries include: petrochemicals, cement, ship building and repair, desalination, food processing, and construction materials. The country currently has limited fresh water resources, but has one of the largest and sophisticated desalination facilities, which provide the country with clean water. Access to sanitary water is extremely high, with a total reaching 99%. Issues Kuwait is currently facing include air pollution, mainly due to oil extracting facilities in the region, and water pollution (desertification), mainly caused by marine dumping. Kuwait is also facing an issue with obesity within their citizen population. The country relies heavily on foreign labor with high immigration rates because of this. Expatriates make up about 70% of Kuwait’s population.

Kuwait has a high life expectancy rate as well as a low maternal and infant mortality rate. Most residents of Kuwait are Muslim, the remaining population consists of approximately 450,000 expatriate Christians, 600,00 Hindus, and 100,000 Buddhists. About 70% of Kuwaiti Muslims are of Sunni faith, while 30% are of Shia faith. Although over 95% of the population is Muslim, Kuwait is known for it’s religious tolerance. As Islam is practiced by many Kuwaitis, it also governs their lives outside the home, including prayer at five different times during the day. The official language of Kuwait is Arabic, but English is widely spoken. The annual population growth rate is 4.0 % per year. 25.32% of the country’s population is below the age of 15, with 15.21% between the age of 15 and 24, and 52.32% of the population is between the age of 25 and 54, 4.82% between the age of 55 and 64, and 2.33% over the age of 65. Extended family is the basis of the social structure and individual identity of a Kuwaiti citizen, which includes the nuclear family, immediate relatives, distant relatives, tribe members, close friends and neighbors, which explains why nepotism is viewed as positive. Family is viewed as private, even though Kuwaitis are known to be hospitable, many still follow cultural norms.

Base Building Building Diagrams

Geometry Study

Structural Column Grid Study

Massing Study

Main Circulation Study

Case Studies

01 Project: The Hisham AlSager Cardiac Center Location: Sabah Medical Region, Kuwait Firm: AGi Architects Project Year: 2015 Area: 15000.0 sqm Focus: Location

The Hisham AlSager Cardiac Center was designed to provide patients with a restorative community that also encourages social activity. The firm focused on leaving behind the typical facade of a healthcare facility and decided to approach the project as a cultural/social building. The location of the Center is strategic in terms of being next to the ocean, where the design takes this into consideration by creating a monolithic geometric shell that rises on one end to increase ocean views from the interior. In order to ensure protection from the harsh climate, the facade is enveloped with clad stone panels. Two main entrances into the building are cut out and recessed from the geometric facade, welcoming patients and visitors both visually and spatially into the building. Entrances are lined with red aluminum panels that wrap the corridors and lead to the central atrium. The atrium is designed to be treated as though the building’s heart. AGi Architects decided to approach the building design using the anatomic scheme of the heart and it’s function within the human body. In order to enhance the interior’s spaciousness and access to natural light, several courtyards wrap around the atrium. Interior surfaces are painted white as well as contributing interior elements in order to allow light to bounce through the space. While floor and wall systems are cladded with stone slabs to create a unified design, tying both the exterior and interior. 10

Conceptually, the design allows patients to move through the central atrium, to enter specific departments within the Center and return to their respected positions after being received, thus passing through the atrium after being rejuvenated. Metaphorically seeing the patients as red blood cells returning to the circulatory system after being re-oxygenated. Each clinical department within the Center is designed as an individual unit run by it’s corresponding head doctor and staff, with each unit amongst three levels towards the south end of the building. Upon entrance, patients are received in a lounge-like waiting room, creating an environment that feels less of a health facility, before entering one of the examination rooms. Each building module contains an interior courtyard, providing access to both natural light, green space, and visual access across the module perimeter. Located towards the north end of the facade, facilities include: a swimming pool, gym, running track, alongside research and administrative services. Double height windows are used amongst the physical activity spaces to provide access to natural light as well as views of the neighboring Bay.

The lobby is directly located in front of the main entrance, providing quick access in case of emergencies. The information desk is located perpendicular to the lobby desk. The coffee area is located adjacent to the lobby and information desk, allowing visitors a casual waiting area before entering to visit patients and providing a more social setting. The security office is located in the space between the information desk and coffee area to ensure safety in case of any hostile incidents. The lecture hall is adjacent to the main entrance and cafeteria area, addressing easy access to users between the cafeteria and entrance. Diagrammatically, the patient pathways and worker pathways are laid out to visually track access points and ease of mobility. Staff rooms and services are located towards the back of the building next to the emergency entrance, to provide quickest access to emergency cases. A prayer room is provided among the Center’s core, allowing only staying patients and/or guests to access the facility, instead of quick incoming patients coming for check-ups. This provides quality control, as well as taking into consideration the Islamic background of Kuwait’s population.

The nurse station is left open on both ends, allowing visual access to passing patients, guests and staff. Entrances to service facilities/ staff offices are not directly accessible from the main interior passage. This allows extended privacy to ensure patients/ guests will not engage with these rooms or have access to any. The main atrium space is only accessible to long term patients and visiting guests, as opposed to short term patients that attend first stage consultation. Design Considerations: 1. Take into consideration Kuwait’s harsh climate when selecting interior materials and finishes. 2. Use the color white to enhance the level of brightness within the space but consider ways to keep the surfaces clean in reference to Kuwait’s dusty climate. 3. Implement interior gardens that are topconcealed, allowing vegetation to survive under harsh climates with controlled shading, ventilation, and irrigation. 4. Use indoor gardens when trying to provide outdoor views to rooms without exterior windows.

02 Project: Nelson Mandela Children’s Hospital Location: Johannesburg, South Africa Firm: Sheppard Robson and John Cooper Architecture Project Year: 2016 Area: 29900.0 m2 Focus: Program

The children’s hospital was designed with a brick facade and large windows to allow ample access to the exterior landscape. The hospital is located within the University of the Witwatersrand’s education campus, in the Parktown neighborhood, to ensure patients have access to a wide range of treatments. The building design compartmentalizes each department creating six individual wings, each with a connection to the outdoors. The main design focus was creating a high quality pediatric hospital that takes advantage of the natural healing environment surrounding it. Thus tying both nature and the built environment to create a welcoming, safe healing space for both children and their parents. A central circulation path extends throughout the building interior, providing access to the six wings over two floors, on both ends on the path. By creating individual modules within the large building mass, the design is focused on a smaller scale which intends to reassure children with something that feels more familiar. Dividing the mass into individual units per wing, allows the project to increase the length of it’s perimeter, allowing the usage of more windows and access to natural landscapes. Interior courtyards are placed between the wings to ensure contact with nature and natural light is provided to all treatment areas. Individual wards are placed on the second floor to increase views of the outdoor landscaping. 12

The design implements both internal and external therapeutic courtyards and gardens using native vegetation and landscaping, allowing for the space to enhance relaxation, treatment, and play for patients during recovery. The exterior facade of the building is clad with red brick, referencing the redclay soil material the region is known for. Horizontal screens used along the exterior windows are solar shades, finished in bright colors to create a distinct personality per department. The firm collaborated with local graphic designers to create a way finding scheme that uses color and graphic symbols that could easily be understood by children using the space. The main focus of the design was to create a direct connection between nature and the healing process.

The main circulation path, referred to as the “circulation spine”, runs along the central axis of the building. The overall layout follows a clear organization, where spaces are divided into square footages based on importance and occupancy. Offices are tucked towards the back of the building, but still have access to natural light. Recovery spaces are located closest to the courtyard garden, indicating patient recovery is the most important focus of the design. Pediatric Intensive Care is also located adjacent to the courtyard garden. The circulation spine, which is the shared circulation path between all the spaces, has clear views of the courtyard, allowing both children, workers and guests to enjoy the views no matter their final destination. Theaters are located towards the back of the building, since it does not need access to natural lighting.

Design Considerations: 1. Provide ample amounts of natural light within the space to reduce energy costs. 2. Implement a “circulation spine” to create a clear navigatory path, allowing users to easily gear towards their final destination. 3. Use color strategically to cater to the young patient demographic. 4. Provide outdoor and internal courtyards and gardens to enhance the recovery process, offering beautifully designed spaces for patients to play, and/or relax. 5. Use native plant species to create a more familiar environment for the both users and staff. This also allows for vegitation to survive in it’s natural climate.

Project: Sheffield Children’s Hospital Location: Northern England Firm: Morag Myerscough Focus: Atmosphere, Graphic Implementation

The hospital was graphically designed to brighten and incorporate playful design elements while still following strict clinical regulations in conjunction to the hospital wards. The main focus was to make the rooms feel more comfortable and domestic for children staying as patients. A single design system could not be used and duplicated into all rooms, for Myerscough created different alterations to suit children with autism, children who cannot handle bright patterns, and older patients. Myerscough’s design intent was to create spaces that did not feel childish, as she knew children of different age groups would be using the space. She focused on creating an environment that both children and their parents would feel good in, as though their child’s bedroom. Due to the required standards, all surfaces within the hospital interior had to be sterile and easy to clean, thus all design components were created with plastic laminate. Bringing in wood texture meant using a screen printed laminate with a wood grain, from Formica. The designer focused on creating a safe environment that felt like home, and proceeded by storing medical equipment and cables behind Formica panels. 14

The colors used within the interior are bright and playful, where the triangular pattern was used effectively as it does not have a direct connotation with offensive or disturbing symbols/ meanings. The wood grain appears as light oak which is more calm and entails what a child’s bedroom would feel like. Bright colors are used incorporating colors that are not gender bias, such as: bright oranges, greens, yellows, and sky blues. Concealing hospital equipment and cables behind Formica cabinets is a great strategy, since many children are afraid of hospital cables, IVs, and equipment in general. Consideration of different age groups entering the hospital is essential, and addressing different children’s needs such as: autism, down-syndrome, ADHD, and other cases, enables the hospital to feel comfortable to all users thus eliminating bias amongst children. Leaving the remaining interior elements white and plain wood grain, allows the colored components to stand out and create a playful atmosphere, without appearing too cluttered and childish.

Project: New Signage System in Hospitals Location: London and Southampton Firm: Pearson Lloyd Focus: Graphic Implementation, Wayfinding

The newly designed signage system was found to reduce aggression and violence from hospital users by 50%. After a one year trial, there was an overall decrease in aggression in both hospitals with the signage systems implemented. The Accident and Emergency (A&C) environment tends to cause users to act upon aggression and verbal misconduct. The main focus of the signage system was to create a calmer atmosphere, resulting in a decrease of violent incidents. The firm collaborated with a multidisciplinary team including psychoanalysts, service designers, A&E consultants and social scientists to pinpoint reasons why patients tend to physically and verbally abuse hospital staff. The main finding after conducting the research, proved to be agitation and frustration towards not knowing and understanding how procedures work in a hospital. The aggression is caused when patients cannot understand clinical terms, or processes such as why some patients are prioritized. The key component of the design focuses on placing simplified graphic information in key locations (such as waiting and consultation rooms), to ensure patients understand the procedures and waiting times per process.

The graphics presented lay out the procedure from start to finish, starting with checking-in and ending with the check-out. These graphic vertical panels are consistent in color and form when placed throughout the hospital in order to make them easily identifiable and cohesive. Digital technologies provide predicted waiting times per department and for different assessments in order to make clear to patients how long they will be waiting, to avoid direct agitation for long waiting times. The design created had to be affordable in order for it to be implemented in different hospital settings no matter the social construct, and also be produced in as little time as possible. Another part of the project addressed recording instances of abuse on a purpose designed chart, which can then be sent to management to assess and accommodate procedural changes. The design firm also created a set of guidelines for designers to follow in order to implement the signage system in any existing or new healthcare facility.

Programming Criteria Matrix Color Legend: Staff Only Staff + Patients Public

High Medium Low

PROGRAMS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Reception Public Cafe Security Room Examination Rooms Diagnostic Rooms Prayer Room Pharmacy Emergency Entrance Emergency Department Intensive Care Unit Sterilization / Septic Theatre Laboratory Patient Changing Room Staff Changing Room Surgical Theatre Meeting Rooms Dr. Offices Nurse Stations Wards Patient Rooms Public Restrooms Staff Restrooms Indoor Garden Space Staff Cafeteria Staff Lounge Staff Entrance Director’s Office Children’s Play Room Education Center Staff Auditorium House Keeping Medical Records Room Janitor’s Closet Storage

Yes No

ADJACENCIES 2, 3, 4, 5, 6, 21 1, 3, 6, 21 1, 2 1, 5, 11, 17, 22 1, 4, 11, 17, 22 2, 4, 5, 17, 19, 25 1, 3 9, 10, 11, 15, 18, 19 8, 10, 11, 15, 18, 19 8, 9, 11, 15, 18 4, 5, 10, 12, 15, 18 11 11, 15, 18, 20 11, 15 9, 10, 11, 13, 14, 18, 19 17, 22, 30 4, 5, 18, 19, 22, 27, 30 4, 5, 9, 10, 11, 19, 20, 11, 18, 20, 21, 23 11, 18, 19, 21, 23 1, 2, 19, 20 4, 5, 12, 17, 18, 19 2, 18, 19, 20, 24, 25, 28 17, 18, 22, 23, 25 17, 18, 22, 23, 24 16, 30 26 18, 19, 20, 21, 23 2, 21 16 18, 19, 20, 33 1,18, 19, 20, 12, 20, 21, 31 31, 32, 33

ACCESS

DAYLIGHT ACCESS

PRIVACY

SPECIAL EQUIPMENT

Programming Functional Diagram

Plan Prototypes

Pre-testing/Intake Room

Exam and Treatment Room

Plan Prototypes

Procedure Room

Imaging Room

Plan Prototypes

Low Vision Polytrauma Training Room

Electrodiagnostics Room

Plan Prototypes

Photography Room

Tomography Room

Plan Prototypes

Visual Fields Room

Ultra Sound Room

Plan Prototypes

YAG Laser Room

Retinal Photocoagulation Laser Room

Plan Prototypes

avoid them, such as patient rooms, or even a wall someone will be looking at that is too bold or bright. Careful consideration should be used when selecting colors, as using certain color palettes in certain areas can cause too much distraction or cause agitation, in spaces that are intended to do otherwise. There is a tendency in not only using the wrong color in wrong spaces, but also using the wrong saturation. Using brighter colors in child associated spaces, and rooms that are more active are more successful than using desaturated tones in these cases. In many cases, colors used in hospitals assist in patient and user wayfinding, this categorizes different parts of a hospital with a specific color scheme. When selecting colors, it is important to study each space and what the space is intended to be used for and how you want the space to be perceived by users. In order to create a balanced environment, using both warm and cool colors will create a sense of tranquility without making an environment too cold, or too distracting. Avoiding extremely saturated colors is effective as these colors can target anxiousness and agitation rather than spark energy. Yet, in different contexts, these colors can benefit child activity rooms or play spaces. Colors can be implemented without having to paint walls, but instead through graphic usage or accents, allowing color to be integrated without overpowering an environment but still being present. The introduction of colors derived from nature is successful in creating an environment that is closely associated with being outdoors, thus colors such as blue and greens are reminiscent of water and greenery, while warmer tones can be associated with warm woods.

Materials in Healthcare AIA Description of Preferred Surface Characteristics 1. Ease of maintenance, cleaning and repairing. 2. Does not support microbial growth. 3. Non-porous - smooth 4. Sound absorption - good acoustics. 5. Nonflammable - Class 1 fire rating or better with low smoke toxicity. 6. Durable. 7. Sustainable. 8. Low VOCs no Off-gassing 9. Low smoke toxicity.

10. Initial and life-cycle cost-effectiveness. 11. Slip resistance - appropriate coefficient of friction. 12. Ease of installation, demolition, and replacement. 13. Non-problematic substrate and / or assemblies. 14. Seamless. 15. Resilient, impact resistant. 16. Control of reflectivity / glare. 17. Options for color, pattern, and texture. 18. Non-toxic / Non-allergenic.

Warmer Tones

Color selection is associated with psychological, visual, aesthetic, and technical aspects of humanmade environments. This results in a color selection derived from geography, culture, and similarly, user characteristics. The question remains, whether or not color has an impact on patients health, staff effectiveness, and facility efficiency. There has not been enough evidence to prove that color has a direct impact on patient health outcomes. Painting walls certain colors did not result in enough evidence to prove their benefit or damage. Though color-mood association exists, certain colors used in healthcare did not prove to exert the same emotion ongoing. An association with warmer tones with stimulating activities and cooler tones with calmer motions still exists. Emotional triggers associated with color are learned through an individualâ&#x20AC;&#x2122;s cultural background, and physiological and psychological state of being. There is an understanding that the usage of darker colors can create a sense of confinement, while lighter tones can create a sense of spaciousness. In conclusion, creating a set of guidelines that should be followed when selecting a color scheme in healthcare is not feasible, as the complexity of user groups and multiple uses of the environment cannot be classified. A userâ&#x20AC;&#x2122;s reaction to color is based on perception, cognition, and physiology. When analyzing color in an environment, factors such as culture, time, and location should be respected in order to create an effective environment that users feel safe and comfortable in. Instead, colors used within healthcare environments should be placed solely based on their function and should serve their specific intent. Improper use of color in healthcare design can include using bright colors in spaces that should

Cooler Tones

Color In Healthcare

Color In Culture Based on a color study conducted in various sites within America, Finland, Japan, Hong Kong, India, and Iran, color connotations were categorized based on concrete associations, abstract associations, and abstract symbolism, that the participants shared. The colors and their proceeding connotations were as follows:

Concrete Associations: Black - dirt Red - sacrifice, heat Yellow - plague Green - spring, nature Abstract Associations: White - heaven, virtue, innocence, purity Black - death, mourning, murder, sin, devil Abstract Symbolism: Green - Prophet Mohammed (PBUH) White - symbol for a flag of truce Red - martyrs

Another color study was conducted on 160 American, Lebanese, Iranian, and Kuwaiti university students with an equal number of males to females in each group. The information listed below indicates the order and percentage of each color preferred over the rest of the colors by Kuwaiti students. Blue-green was the most preferred color combination from the group of colors, while blue was preferred least as a stand alone color when ranked amongst the other colors.

1. Blue-green

67.5%

2. Yellow-green

60.4%

3. Green

57.8%

4. Orange

56.8%

5. Purple

47.1%

6. Yellow

38.9%

7. Red

37.1%

8. Blue

34.3%

Accessibility Restrooms

Accessibility Doors + Ramps + Stairs

Accessibility Egress Tables + Fire Performance

Accessibility Code Calculations Occupancy Classifications

Occupancy Factors

1. Institutional (I-2) (I-4) 2. Assembly (A-2) (A-1) (A-3) (A-5) 3. Business (B) 4. Storage (S-1)

Sleeping..........................................................120 Gross Outpatient......................................................100 Gross Inpatient..........................................................240 Gross Day Care..........................................................35 Net Kitchen (Commercial).....................................200 Gross Locker Rooms.................................................50 Gross Offices.............................................................100 Gross Standing Space..............................................5 Net Concentrated Assembly................................7 Net Unconcentrated Assembly.............................15 Net Storage............................................................300 Gross

Sleeping........................................................... Institutional (I-2) Outpatient....................................................... Institutional (I-2) Inpatient........................................................... Institutional (I-2) Day Care.......................................................... Institutional (I-4) Kitchen (Commercial)...................................... Assembly (A-2) Locker Rooms.................................................. Business (B) Offices.............................................................. Business (B) Standing Space............................................... Assembly (A-3) Concentrated Assembly................................. Assembly (A-1) Unconcentrated Assembly............................. Assembly (A-2) Storage.............................................................Storage (S-1) Total Sq. Footage Level 1 Sleeping..........................................................120 (30 each) Outpatient......................................................120 (30 each) Inpatient..........................................................120 (30 each) Day Care..........................................................1500 (2 each) Kitchen (Commercial).....................................400 (3 each) Locker Rooms.................................................100 (3 each) Offices.............................................................500 (10 each) Standing Space..............................................200 (4 each) Concentrated Assembly................................1500 Unconcentrated Assembly.............................1000 (5 each) Storage............................................................500 (6 each)

Diagonal For Egress: 169’ 4” Building Sprinklered: Yes Max Travel Distance to Exit: 169’ 4” Distance between Fire Rated Stair Towers / Exits minimum: 84’ 6” 32

Lavatories

Day Care

Kitchen (Commercial) Locker Rooms Sleeping Outpatient Inpatient Business Standing Space

1 3

3 3

Concentrated Assembly Unconcentrated Assembly Storage

3 3 3

Max Travel Distance to Exit (sprinklered)

Occupancy Loads Level 1 Sleeping..........................................................30 Outpatient......................................................36 Inpatient..........................................................15 Day Care..........................................................86 Kitchen (Commercial).....................................6 Locker Rooms.................................................2 Offices.............................................................50 Standing Space..............................................160 Concentrated Assembly................................215 Unconcentrated Assembly.............................334 Storage............................................................10 __________________________________________ Total Number of Occupants = 944

Occupancy

Group A

200

Group B

300

Group I

S. S

1 3

1 1

1 1 1 1 1 1 1

1 1 1

30 Unisex WCs with lavatory 30 Unisex WCs with lavatory 30 Unisex WCs with lavatory

Max Dead End Corridor Length (ft)

Minimum Corridor Aisle Width (inch)

20’

44”

50’

44”

with automated sprinkler system

(Unrestrained)

200

20’

44”

Group S

400

50’

44”

Minimum Egress Corridor Width Group I-2: 96” Group B: 44” Outpatient Rooms: 72” Required Exits Three exits required on the first floor because occupancy load per level is less than 1000. Door Size Required to Comply with ADA Standards: Minimum 32”

Maximum 48”

Accessibility Door Clearances

Thesis Focus With a population expected to increase over the next few years, the Ministry of Health in Kuwait has responded to the need of a larger, and more advanced healthcare facility. As the newest facility, Jaber Al-Ahmad Al-Sabah Hospital, is slowing opening up itâ&#x20AC;&#x2122;s departments, there is still a need for public pediatric specialized facilities. With 25.32% of the population under the age of 15, there are limited amounts of public specialized facilities designed to cater to the young demographic in Kuwait. Along with an increase of technology usage by the younger population, more eye conditions are likely to arise. The largest public eye center currently in Kuwait is also in a location prone to air pollution coming from automobiles on the highway and water pollution as the neighboring Gulf is releasing unpleasant odors caused by marine dumping. Although public hospitals in Kuwait are effective in providing exceptional medical care to all their patients, they lack overall design integration of wayfinding, positive atmospheres, and spaces that cater to patient and staff well-being. The Pediatric Ophthalmology Center will target designing for Kuwaitâ&#x20AC;&#x2122;s younger population by creating a safe and enjoyable environment that aims to provide effective wayfinding components integrated within the facility design. Located in Al-Shuhada, the Center is strategically located by the Jaber Al-Ahmad Al-Sabah Hospital in order to take patient referrals while occupying a space that is far from concentrated levels of pollution. The Center will also prioritize patient and staff physical and mental well-being by integrating components from the WELL Building Standard. Partaking in sustainable practices will encourage users to respect the facility environment and also reduce energy and maintenance costs over the facilityâ&#x20AC;&#x2122;s lifespan. The incorporation of multiple designated garden spaces throughout the facility will progress healing, reduce stress, and increase user satisfaction.

Goals + Objectives 1 2

Goal: Provide an environment that is welcoming and enjoyable to occupy. Objectives: 1. Detect and use a color and material palette that is associated with tranquility. 2. Avoid the usage of design elements that serve no purpose to create a clutter-free environment.

Goal: Create a healthcare facility that withstands time and is sustainable. Objectives: 1. Incorporate local materials that are able to withstand Kuwaitâ&#x20AC;&#x2122;s harsh climate. 2. Select materials with a high resistance to weathering, wearing, tearing, and damage. 3. Distinguish key elements that can benefit from solar energy and harvesting. 4. Develop a landscaping courtyard plan that can be integrated within the interior, addressing the high temperature and strong direct sun. 5. Select plant species native to the region that can withstand the harsh climate. 6. Implement materials based on their ability to retract heat, or have antimicrobial properties.

Goal: Establish a strong interior identity that respects Kuwaitâ&#x20AC;&#x2122;s culture.

Goal: Holistically address wayfinding.

Goal: Create a safe environment for both children and family members to occupy.

Objectives: 1. Determine elements that can be derived from Kuwaitâ&#x20AC;&#x2122;s environment and/or traditional culture. 2. Incorporate both Arabic and English signage systems as these two languages are most widely spoken. 3. Integrate special design elements and facilities that are required in spaces located in Kuwait.

Objectives: 1. Apply signage systems that can be easily comprehended by both children and adults. 2. Create signage systems that are attractive and effective within the space. 3. Use color coding in order to map individual spaces allowing users to color coordinate even without signage systems. 4. Map out the floor plan as a user and address points of relevance that require wayfinding elements.

Objectives: 1. Avoid the usage of sharp angles within the design of the interior that may harm rushed users. 2. Use playful colors within spaces children will occupy to feel more like play centers. 3. Use graphics to educate children on maintaining a healthy lifestyle as well as create a positive environment. 4. Integrate play spaces where children can interact and feel at home. 5. Assess lighting that creates a natural lighting effect within all spaces in the facility, in order to avoid the fluorescent lighting associated with hospitals. 6. Provide design elements within the facility that children can associate with, and both staff and family members will not get tiresome of.

Research Interviews. User Experience in Different Cultures. Conducted by Corrie Chamberlin + Reem Bukhamseen

Conducted phone interviews with a variety of healthcare users including patients, volunteers, clinicians and aides. Interviewees responded based on experiences in different facilities in the Kuwaiti region and multiple regions in Virginia. Within these interviews a previously established set of

questions was presented to all participants. One interviewee provided visual documentation of the facility in which she practices. Later examined and synthesized responses based on regional and universal needs of users in a healthcare facility.

7 participants

Set of Questions Asked:

3 from Kuwait - 2 patients - 1 doctor / consultant 4 from Virginia - 1 volunteer - 2 student aides - 1 nurse

Name Age Gender Position (dr, nurse, patient, etc.) Position Duration Facility Name Facility Location 1. In which room do you spend the most time? A) Would you make any improvements in this room, if so, what would they be and why.

7 facilities 3 from Kuwait - Al-Seef Hospital - Al-Bahar Hospital - Dar Al-Shifa Hospital 4 from Virginia - Carilion Roanoke Memorial Hospital - Eye Care and Surgery - Chesapeake Regional Medical Center - Capital Caring Advanced Illness Care and Support

Facilities Discussed in Interviews (Only facilities with logos are placed below)

B) What do you find is working successfully in this room? 2. What rooms and/or amenities would you like to see provided in the facility, and why? 3. Would you like to see anything improved in the facility, if so, what and why? 4. What rooms or amenities are necessary to provide based on regional culture? 5. Describe the most common patient and staff interactions that you have experienced, and how they are affected by the room/ environment.

Research Interviews

Findings + Analysis Photos Provided by User in Al-Bahar Hospital, Kuwait.

4. 2.

Overall Findings:

Analysis on Human Behavior

1. Provide a comfortable spacious reception / waiting area with enough privacy. 2. Front desk needs to be directly accessible with staff that are fully knowledgeable behind the desk. 3. Provide the option for a guest to stay overnight with an inpatient. 4. Use up-to-date medical technologies that are easy to use and won’t malfunction. 5. Provide a private cafeteria lounge and/or cafe for staff. 6. Provide a pleasant nursing room and a well designed prayer room (when culturally appropriate). 7. Cleanliness is extremely important to all users of the facility. 8. Enough parking spaces need to be provided. 9. Create a multi-functional reception (includes coffee shop, pharmacy, gift shop, etc.). 10. Staff need enough space for personal items and storage. 11. Healthcare facilities should provide wifi to all users. 12. Access to nature and natural light are crucial for user’s wellbeing. 13. Give the option to staff to choose to sit or stand when working. 14. Provide private rooms for staff to be alone to deal with emotional reactions during the job. 15. Accessibility is the top priority when catering to elderly users and patients. 16. Wayfinding and future expansion need to be considered during design. 17. Organize spaces based on best functionality usage. 18. Provide a bridge for language barriers. 19. Always prioritize the patient’s needs, while complying with rules and regulations. 20. Provide segregated seating areas in the waiting room for both men and women (when culturally appropriate).

Perception 1. Patients perceived each space based on their cultural background and past experiences. 2. Spaces were perceived visually first. Adaptation 1. Users of the space did not find much to improve about the space if they had been familiar with the environment for a longer period of time. Stimulus Response 1. Users response was dictated by prior knowledge of what rooms in a health facility should have and look like. 2. Users expectations or lack thereof, affected how that user perceived the space. 3. User personality affected how each user viewed the space. Affiliative Conflict Theory, Cultural Variances 1. In eastern cultures, it is unacceptable to stare in public, one reason why public facilities provide segregated seating for females and males in waiting rooms in Kuwait. 2. Prayer rooms were available in all the healthcare facilities in Kuwait mentioned above. 3. In western cultures, more space was needed for families to gather in the waiting room area due to a need of wider distances for personal comfort. Picture Descriptions: 1. View of hallway entering operating rooms. 2. View of female waiting area in reception. 3. Graphic and signage indicating male waiting area. 4. Room layout in examination room. 5. View of operating room. 6. Emergency exit route floor plan in hallway.

Research Garden Spaces in Healthcare Facilities Different Types of Outdoor Spaces Used in Hospital Facilities: 1. Landscaped Grounds 2. Landscaped Setback 3. The Front Porch 4. Entry Garden 5. Courtyard 6. Plaza 7. Roof Terrace 8. Roof Garden 9. Healing Garden 10. Meditation Garden 11. Viewing Garden 12. Walk-In Garden

Landscaped Grounds This garden space is located at ground level creating an outdoor space, usually between buildings. This space usually becomes a walking route between buildings, a break area, or an outdoor seating area. Advantages: - Can connect surrounding buildings into a community-like setting. - Multi-functional space can accommodate different users and activities. Disadvantages: - Requires heavy maintenance.

Landscaped Setback This garden space is located towards the front of the healthcare facility, it usually contains trees and bushes by the main entrance. Advantages: - Can be a comforting sight upon entering the facility. - Rooms by the front perimeter of the building have more privacy. Disadvantages: - This space tends to be overlooked, or misused as it contains no seating or pathways for users to engage.

The Front Porch Equivalent to a houseâ&#x20AC;&#x2122;s front porch, this setting refers to facilities with overhangs by the main entrance, vehicle turnarounds, outdoor seating, and/or bus stops. Advantages: - Allows the user to visually locate the main entrance. - Overhang can bring down the facility scale to a more intimate one. - Provided seating is functional for visitors waiting to be picked up without overcrowding the reception area. Disadvantages - Can easily be overused if seating is only provided outdoors. - Can be under used if entrance to the facility is also through underground parking.

Research Garden Spaces in Healthcare Facilities

Entry Garden Garden space provided by the facility towards the main entrance that is well designed to accommodate user engagement. Advantages: - Easy to access and visually apparent. - Positively uses space that could have been used for parking. - Creates a pleasant sight upon entrance. Disadvantages: - Needs to be planted strategically in order to avoid parking disruption of views.

Courtyard Considered the center core of a facility, this garden space becomes a focal point in the facility visually accessible from different departments and rooms. Advantages: - Partially private and secure, space is surrounded by healthcare facilities. - Can be accessed both visually and functionally if placed in strategic location. - Core placement provides wind shield as well as shade from the building structure. Disadvantages: - With unproportional arrangement, can become an uncomfortable setting. - If made too small with few blocking plants, opposing rooms may need to use blinds for privacy.

Plaza Hard surfaced space resembling an urban plaza, that is outdoors with provided furniture for use. This space usually has vegetation in planters or smaller scale green spaces. Advantages: - Maintenance is low and cheap. - Can easily accommodate more than one function. - Patients requiring mobility assistance can use the space without trouble. Disadvantages: - Can be viewed as a dull due to lack of vegetation and color. - Can be conceived as a shopping mall or office plaza setting rather than a therapeutic setting.

Roof Terrace Considered a long narrow outdoor balcony along the building, this space is on top of the facility. This space usually provides different kinds of seating, and planters. Advantages: - Takes advantage of a space that can easily be disregarded. - Allows users to get more clear outdoor views. Disadvantages: - Can be uncomfortable setting based on location climate (i.e. heavy winters, dry summers, windy days). 41

Research Garden Spaces in Healthcare Facilities

Roof Garden Garden located on the facilityâ&#x20AC;&#x2122;s roof. This space is designed for users to enjoy an outdoor setting, landscaped for that purpose. Advantages: - Takes advantage of space that can be disregarded. - Garden space becomes private, only accessible to facility users. - Gives users better city scape views. Disadvantages: - User can experience harsher climate due to higher elevation (i.e. more wind, more heat). - Surrounding buildings may block sunlight, causing temperatures in the garden to be more uncomfortable.

Healing Garden Can be either an indoor or outdoor garden space dedicated by the designer to be used for healing purposes. Advantages: - Users expect space has been well designed to be more therapeutic. - Space will limit activities in the garden to control disrupting users. Disadvantages: - If the space provided is too small, users may feel uncomfortable to use the space. - If the space is not labeled as such, users may misinterpret itâ&#x20AC;&#x2122;s usage.

Meditation Garden Small enclosed space designated for meditation only by the designer or administrative staff. Advantages: - Gives users a quiet space to reflect, relax, or contemplate. - Discludes disrupting activities. Disadvantages: - If not properly concealed, users may feel uncomfortable using the space. - With its designated purpose, users may feel conducting other quiet activities in the space is not allowed.

Viewing Garden Small garden space provided by the facility that cannot be entered, but can be viewed by users in the facility. Advantages: - Provides a green space in a small footprint. - Gives users access to green space without having to deal with weather conditions. - Garden is low maintenance. Disadvantages: - Vegetation cannot be fully experienced by looking through a glass wall (i.e. sounds of birds or water fountains).

Research Garden Spaces in Healthcare Facilities

The Walk-In Garden An indoor garden space that can be viewed from inside the facility that can also be accessed by users of the facility in limited quantities. Advantages: - Provides users with a green space view while occupying the facility. - Offers users a quiet seating area as limited seats are available. - With low numbers of users in the space, adjacent rooms will not feel their privacy is being invaded. Disadvantages: - Users in the garden may feel they are being looked at constantly by surrounding rooms.

Designing Better Garden Spaces in Healthcare Facilities After a researcher observed over one hundred hospital gardens in four countries (United States, Canada, United Kingdom, and Australia), a list was indicated on what needs to be considered in order to provide a garden that can be used to itâ&#x20AC;&#x2122;s fullest potential.

Provide opportunities for users to exercise and move within the garden.

Give users opportunities to make choices, contemplate, feel a sense of control, and enjoy privacy.

Provide the setting for users to gather together and experience social support from one another.

Provide the space for users to engage with nature.

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Provide a quiet space throughout the garden.

Consider all users comfort.

Provide ambiguously positive art that indirectly delivers positive messages to the viewers.

What Can a Healing Garden Do?

Aid in stress reduction allowing the body to reach a more balanced state.

Assist a patient in allowing his or her body to release their inner healing resources.

Allow a patient to come to terms with a incurable medical condition.

Consider visibility.

Provide patients and guests a more relaxed setting to interact and engage.

Consider how the garden will be accessible to all users of the facility including compliance with ADA standards and universal design.

Use the space to conduct different types of therapy with the patients.

Allow staff to destress from work shifts during the day, when a retreat is needed.

Give users a sense of familiarity when using the garden.

Research Wayfinding Interactive Wayfinding Displays in Hospitals Three interactive touch screen displays were used in three different hospital environments. One is a traditional kiosk, one is a touch screen situated on a counter, and the third is a flat touch screen mounted on a wall. All three interactive devices were placed near the entrance or common areas of the hospitals. Researchers indicated, after testing the systems by allowing multiple users to follow a given path using only the interactive displays, that each system had itâ&#x20AC;&#x2122;s faults when adhering to users of the space, that are unfamiliar with the building. Design recommendations given by the researchers after conducting the study, include the following:

Design Recommendations for Interactive Touch Screens

Take user experiences into consideration when classifying information on the interactive system. As many of the interfaces categorized information that users would not be able to follow.

Incorporate a universal search option. Systems provided only allowed the user to find locations through entering different tabs, leaving users confused as to where they should find what theyâ&#x20AC;&#x2122;re looking for.

Limit unnecessary on-screen information. Users inability to retain large amounts of information meant it was harder for users to remember what tabs they viewed earlier.

Comply with interface platform standards. Users tend to follow a universal system of interfaces, and when presented otherwise, tend to make more errors.

Visual aids should be presented effectively. Users were unable to distinguish these aids as they were presented at poor timings, lack of distinction, or overpowered by other information on the screen.

Evaluation In Context

Provide users with more environmental cues. Participants of the study were able to locate destinations much easier when signage, color schemes, and memorable landmarks were used within the hospital.

Consider an overall culture that encourages users to seek assistance from the staff. This enables users to seek assistance when left unable to navigate.

Accessibility needs to be considered. Interactive screens were situated too high to be accessible by wheelchair users.

Research Wayfinding Detecting Hospital Wayfinding Difficulties by Simulating Visual Impairments This study was conducted by Justin B. Rousek, Sonja Koneczny, and M. Susan Hallbeck, to identify current issues in navigating through a healthcare facility for the visually impaired. With an understanding that many facilities have been developed with little consideration to the visually impaired users, this study compared both experiences within one facility. Fifty participants with full vision (25 male, 25 female) were asked to navigate through the facility wearing one of the five simulation goggles that replicated the vision of a user with a visual

Findings

The study shows that for visually impaired users in a healthcare facility, decorative elements tend to cause high disturbances when navigating through the space.

As these users could have other age related conditions, their struggles may put the users at a higher risk of accidental injuries.

Lighting changes in hospital facilities are usually seen as misleading. As the view can alter the actual dimension of the doorways and hallways to appear either bigger or smaller than the actual size.

Size, illumination and placement of signage received negative feedback as they may have not addressed users with visual impairments.

Many of the users misdirections tended to occur in open areas of the facility. The users had difficulty following signage systems in open spaces, as they were used to following hallways and corridors. Providing hallways in these open areas using partition walls could help users navigate better as there is less change indirection in a hallway setting.

Floor pattern changes on the floor were commonly misinterpreted as steps by the users. The usage of shiny tiles in these spaces made the flooring appear wet, which can put the users at risk if combined with other age related conditions.

Many of the participants ended up getting lost. These users would potentially take even longer to find their final destination if they are in circulation paths without staff available to assist them.

Participants complained that the lighting within the facility changed too often, as some spaces were darker, too bright, or even only used natural light from windows. The proportions of the lighting implemented could cause unwanted glare and reflections causing user discomfort.

impairment. Each of the five goggles replicated the vision of users with: diabetic retinopathy, glaucoma, cataracts, macular degeneration, or hemianopsia. The participants then were told to navigate through the space without the simulation goggles in order to identify the issues faced as a visually impaired user in a healthcare facility. The times it took for the participants to complete each task with and without the goggles were noted to see how much longer it can take for visually impaired users to navigate through a facility. Different Goggle Views

Research Pediatric Ophthalmology Understanding What is Ophthalmology?

Who are the specialists?

“The branch of medicine that deals with the anatomy, physiology, diseases, and treatments of the eye.”

1. Ophthalmologists Medical specialist that is trained in the medical and surgical management of childhood eye conditions, that include but are not limited to glaucoma, cataracts, and prematurity related eye disorders.

Pediatric Ophthalmology?

2. Optometrists Medical specialist that conducts regular eye exams for children to ensure the vision is not interrupted and prescribe lenses as needed.

Is a subspecialty in Ophthalmology that caters to childhood eye diseases, conditions and treatment. Provided Center Treatment and Services: - Childhood Glaucoma - Eye Cancer - Eye movement disorders - Optic nerve disorders - Retinal Disease - Retinoblastoma - Routine Eye Care - Amblyopia “Lazy Eye” - Strabismus “Misalignment of Eyes” - Brain disorders that affect vision - Retonopathy of Prematurity (ROP) - Ptosis

Services Offered? - Diagnostic Testing Center - Optical Shop - Eye Surgical Network - Strabismus Center - Subspecialty Services - Eye Emergency Department

Procedure 1. Have a pediatrician examine your child’s eyes within their first year of life. If there is a family history of eye diseases or if you or your doctor identify an abnormality in the child’s eyes refer to an ophthalmologist. 2. Children should undergo a comprehensive eye exam before their fourth year of life if vision appears to be developing normally. Then make another visit every two year thereafter. 3. Treatment of childhood diseases and early diagnosis can provide better visual results for the child as they grow older. 46

3. Pediatric Optometrists Medical specialist that uses diagnostic equipment to assess a child’s vision and current eye health. 4. Neuro-Ophthalmologists Medical experts who specialize in eye conditions that relate, or are caused by neurologic conditions. 5. Cornea Specialists Medical specialist who manages vision-threating corneal conditions. 6. Vitreoretinal Specialists Medical specialist that treats children with retinal and optic nerve diseases that disrupt eye vision. 7. Oculoplastic Surgeons Medical specialist that can perform surgery on the eyes, face, tear system, and the surrounding facial structures to the eye in order to improve child’s appearance after cancer, trauma, or congenital defects. Fundamental Equipment List: Operation Theatre Equipment: 1. Operating Microscope - for microsurgery. 2. Vitrectomy machine - for vitreous work. 3. YAG laser - for a surgical procedure in the treatment of glaucoma and for the treatment of the posterior capsule opacification following extra Capsular Cataract Extraction. 4. Autoclave - for sterilization. Outpatient and Refraction Equipment: 1. Slit lamp - to look at different parts of the eye in sections and at different depths. 2. Direct Ophthalmoscope - to look into the eye (findus). 3. Indirect ophthalmoscope - to look into a deeper area of the retina, than the direct ophthalmoscope can see. 4. Findus camera. 5. Refractometer - to measure the axial length of the eye and for calculation of the IOL power. 6. Keratometer - to measure the power of cornea, a factor needed for contact lens prescription; also for calculation of power of intraocular pressure). 7. Streak retinoscope - for objective evaluation of refractive error.

Research Plan and Layout Sample

Strategies To Reduce Energy Use + Maintenance Costs

Provide an irrigated garden around the perimeter of the building to cool the area at the base of the hospital. This will also allow for dust to lay, reducing air conditioning usage.

Use the building shape to provide rooms with cross ventilation, such as by creating a central courtyard and single loaded verandah plan.

3 4

Use paints with extremely low VOCs that reflect light and are easy to maintain.

5 6 7

When selecting materials, use heavy gauge materials that wear well over time.

8 9

Before entering the medical facility, provide a heavily planted garden right before the main entrance.

Limit the dependence on emergency power by taking advantage of daylight in most spaces, that do not require artificial light to function well.

Encourage the reuse and recycling of waste products such as paper, grey water, organic wastes from catering, bottles, and so forth.

12 13

Select materials that absorb the dayâ&#x20AC;&#x2122;s heat for reradiation at night, that trap and hold the cool night air.

Use locally made and repairable doors, windows and cabinets, which allow for quicker maintenance and repair when necessary.

Provide dense vegetation that will allow for shading on walls and windows. Place more sensitive activities furthest away from the main entrance. Activities closest to the main entrance accumulate the most dust. Instead place them towards the inner part of the hospital where dust is controllable.

Mopping and cleaning of the facility must occur a minimum of three times daily.

Provide plenty of shading and minimize daytime ventilation without affecting any procedures in the facility.

Research The WELL Building Standard WELL Features + Objectives

AIR Create ideal indoor air quality in order to support the health and well-being of the building users. - Provide natural ventilation methods. - Provide operable doors and windows. - Provide effective ventilation. - Reduce VOCs when selecting paint, flooring, furniture and finishes. - Control microbe and mold through preventative measures. - Provide effective air filtration. - Manage pesticides. - Use antimicrobial high-touch surfaces. - Clean equipment regularly and provide a cleanable environment to occupy. - Ban smoking indoors. WATER Advocate clean water through the integration of proper filtration and regular water testing in order to provide users with safe water. - Conduct periodic water quality testing. - Promote users to drink more water. - Give occupants close access to drinking fountains. - Proper treatment of water before delivering to users. NOURISHMENT Encourage healthy eating habits and make fresh, wholesome foods more available. - Make fruits and vegetables appealing and available. - Provide handwashing facilities with paper towel dispensers and liquid soap near food stations. - Advocate proper serving sizes to users. - Provide healthy foods that accommodate special diets. - Promote mindful eating habits. - Consider food allergies and nutrition labeling. - Avoid providing foods with artificial ingredients. LIGHTING Provide adequate lighting systems that minimize the disruption of the circadian rhythm, while still enhancing productivity and visual acuity. - Control glare in the environment and provide effective shades with controls. - Set thresholds for indoor daylight exposure. - Design a lighting system that follows the circadian cycle of the human body, and can be dimmed. - Use surface materials with a high LRV. - Specify lamps with quality color rendering abilities. - Set limits on the luminous intensity of luminaires to minimize glare. 50

Research The WELL Building Standard WELL Features + Objectives

FITNESS Integrate exercise and fitness into usersâ&#x20AC;&#x2122; lifestyles by providing the physical features within the design to promote active and healthy lifestyles. - Offer on-site professional fitness equipment, training and education. - Make stairs, entry ways, and corridors more visually appealing to encourage use. - Provide outdoor pedestrian friendly amenities (ex. benches, bike racks, plaza, garden space, walking routes). - Provide a shower and changing facility for users. - Provide indoor and outdoor physical activity spaces. - Offer active workstations to occupants. COMFORT Create distraction-free, productive and enjoyable indoor environments for occupants. - Incorporate furniture selections that address ergonomics. - Specify sound reducing surfaces that control unwanted noise. - Personalize thermal comfort amongst occupants. - Specify impact reducing flooring to limit acoustic disturbances from footsteps. - Implement sound masking elements into the building design. - Limit external noise. - Provide buildings that are accessible and usable by all types of users. MIND Provide a physical environment that optimizes cognitive and emotional health. - Educate users on factors that can impact their health and well-being. - Conduct post-occupancy surveys. - Incorporate design elements inspired by nature. - Provide access to stress management programs. - Discourage occupants from working late hours in the office. - Provide users access to more private spaces. - Create special culturally-rich spaces. INNOVATION Continue education in how interior spaces are contributing to health and wellness of occupants. - Propose a new feature that addresses health and wellness in a new way that impacts users positively. - Proposal is supported by scientific, medical, or industry research. - Proposal is in line with current laws, regulations, as well as building design and management practices.

Works Sited Culture + Demographics

Programming + Plan Prototypes

Kuwait Guide. (n.d.). Retrieved November 07, 2017, from https://www.commisceo-global.com/ country-guides/kuwait-guide

United States, US department of Veteran Affairs, Office of Construction & Facilities Management. (2017, July). Eye Clinic: Ophthalmology and Optometry Services. Retrieved November 11, 2017, from https:// www.cfm.va.gov/til/dGuide/dgEye.pdf

Kuwait Population 2017. (n.d.). Retrieved November 07, 2017, from http:/ worldpopulationrev iew.com/countries/kuwait-population/

Case Studies Giffiths, A. (2016, July 15). AGi design Cardiac rehabilitation centre on Kuwait Bay. Retrieved November 15, 2017, from https:// www.dezeen.com/2016/07/17/hisham- a-alsager-cardiac-center-agi-architects- medical-rehabilitation-centre-kuwait/ Griffiths, A. (2017, July 21). Nelson Mandela Children’s Hospital combines concrete and brick with colourful details and big windows. Retrieved November 10, 2017, from https://www.dezeen. com/2017/05/13/nelson-mandela- childrens-hospital-concrete-brick-colourful- windows-architecture-health-sheppard robson-john-copper-south-africa johannesburg/ Aouf, R. S. (2017, February 03). Morag Myerscough brightens the wards of Sheffield Children’s Hospital. Retrieved November 10, 2017, from https://www.dezeen.com/2017/02/05/ morag-myerscough-bright-colour-wards- sheffield-childrens-hospital-interiors-uk/ Griffiths, A. (2013, November 29). PearsonLloyd hospital redesign “reduces violence by 50 percent”. Retrieved November 10, 2017, from https://www.dezeen.com/2013/12/02/ hospital-redesign-by-pearsonlloyd-reduces violence-and-aggression/

Materials + Infection Rossi, M., & Lent, T. (2006). Creating Safe and Healthy Spaces: Selecting Materials that Support Healing. Creating Safe and Healthy Spaces: Selecting Materials that Support Healing, 1-29. Retrieved November 3, from https://www. healthdesign.org/system/files/Creating%20 Safe%20and%20Healthy%20Spaces.pdf.

Coffin, C. J. (2001). Architectural Design for High Quality, Large Volume, Sustainable Cataract Surgery Programmes. Architectural Design for High Quality, Large Volume, Sustainable Cataract Surgery Programmes, 1-65. Retrieved November 3, from http://www. aravind.org/content/downloads/ Archdesign.pdf Pediatric Ophthalmology. (n.d.). Retrieved November 27, 2017, from https://www. dukehealth.org/pediatric-treatments/ pediatric-eye-diseases Medical Services. (n.d.). Retrieved November 28, 2017, from https://www.willseye.org/ medical-services/ The 21st Century Child: Increased Technology Use May Lead to Future Eye Health and Vision Issues. (n.d.). Retrieved December 1, 2017, from https://www.aoa.org/newsroom/the 21st-century-child-increased-technology use-may-lead-to-future-eye-health-and vision-issues

Gardens in Healthcare Marcus, C. C., & Barnes, M. (1995). Gardens in healthcare facilities: Uses, therapeutic benefits, and design recommendations. Martinez, CA: Center for Health Design. Cooper, C. (2007). Healing Gardens in Hospitals. IDRP Interdisciplinary Design and Research e-Journal, 1(1), 1-27. Retrieved November 29, 2017, from https://s3.amazonaws.com/ academia.edu.documents/41509609/ Healing_Gardens_in_Hospitals.pdf?A WSAccessKeyId=AKIAIWOWYYGZ2Y53U L3A&Expires=1512305821&Signature =VYvPjweYY%2FUoyLM4pbY9kXPhPX0% 3D&response-content disposition=inline%3B%20 filename%3DHealing_Gardens_in_ Hospitals_not_mine.pdf.

Works Sited Wayfinding Research

Air - Ventilation

ROUSEK, J. B., KONECZNY, S., & HALLBECK, S. (2009). Simulating Visual Impairment to Detect Hospital Wayfinding Difficulties. Simulating Visual Impairment to Detect Hospital Wayfinding Difficulties , 1-5. Retrieved November 24, 2017, from http://journals.sagepub.com/doi/ pdf/10.1177/154193120905300810

Sehulster, L., & Chinn, R. (2003, June 6). Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Retrieved November 10, 2017, from https://www.cdc.gov/mmwr/ preview/mmwrhtml/rr5210a1.htm

Harper, C., Avera, A., Crosser, A., Jefferies, S., & Duke, T. (2017). An Exploration of Interactive Wayfinding Displays in Hospitals: Lessons Learned for Improving Design. 1-4. Retrieved November 25, 2017, from http://journals. sagepub.com/doi/ pdf/10.1177/1541931213601884

Color Research

Codes Compliance, A. (n.d.). Doors. Retrieved November 07, 2017, from http://www.ada-compliance. com/ada-compliance/ada-doors.html International WELL Building Institute. (2017, November 29). Retrieved November 20, 2017, from https://www.wellcertified.com/ T., & T. (2006). Guidelines for Design and Construction of Health Care Facilities. New York, NW: The American Institute of Architects. “Planning Guide for Accessible Restrooms.” Bobrick. 5 March 2016 ,http://www. bobrick.com/documents/planningguide. pdf. Accessed 23 November 2017 International Code Council.International Code Council, INC. 2016, http://www.iccsafe.org/. Accessed 23 November 2017.

Young, J. M. (2007, August 31). A summary of Color in Healthcare Environments: A Critical Review of the Research Literature. Retrieved October 24, 2017, from https:// www.healthcaredesignmagazine. com/architecture/summary-color healthcare-environments-critical-review research-literature/ Silvis, J. (Ed.). (2012, May 11). Healing Hues: Choosing Paint Colors for Healthcare. Retrieved October 24, 2017, from https:// www.healthcaredesignmagazine.com/ architecture/healing-hues-choosing-paint colors-healthcare/ Byrne, M. (2006). Culture & Communications: Similarities of Color Meanings Among Diverse Cultures . THE BI-MONTHLY JOURNAL OF THE BWW SOCIETY, 1-10. Retrieved November 25, from https://pdfs.semanticscholar.org/7205/ f0869ab586d36fecf5e8c5d5ea0c4dad1182. pdf. Choungourian, A. (1988). COLOR PREFERENCES AND CULTURAL VARIATION . 1-4. Retrieved December 1, from http://journals. sagepub.com/doi/pdf/10.2466/ pms.1968.26.3c.1203

Harmon, Sharon. The Codes Guidebook for Interiors. John Wiley & Sons, 2011. International Building Code 2015. 2016 ICC, http:// codes.iccsafe.org/app/book/ toc/2015/I-Codes/2015%201BC%20 HTMUindex.html. Accessed 23 November 2017.

Content Expert Name: Dr. Mona Ahmed Al-Saleh Position: Consultant Ophthalmologist Facility: Al-Bahar Eye Center Facility Location: Sabah Health Region Experience: Thirty Years Experience Design Collaboration 1. Provided list of spaces needed in a Pediatric Ophthalmology Center, assisted in creating the programming for the Pediatric Facility. 2. Discussed amenities needed that were not provided in her current facility. 3. Provided visual documentation of current workplace. 4. Will provide a full tour of the hospital facility before start of Spring Semester. 5. Scheduled meeting in December to discuss detailed procedures and needs per room and facility in a Pediatric Ophthalmology Hospital.