Principles of Hospital Architecture - Part One

Principles of Hospital Architecture - Part One

Classification of hospitals in terms of level, volume, and type of services
General Hospital (Multi-Specialized)

General hospitals, also known as multidisciplinary hospitals, offer a wide range of specialized and sub-specialized services and are not limited to one or more specialties. The general hospital should have at least four inpatient wards, including an inpatient ward, surgical ward, obstetrics and gynecology ward, and pediatric ward 1 with a group of specialist physicians, and laboratory, pharmacy, radiology, emergency, and nutrition wards. They are inseparable.
Specialized hospital (single specialized)
Specialized hospitals, also known as single specialized hospitals, provide specialized and comprehensive diagnostic, care, and treatment services for one or more specific groups of patients. In fact, a specialized hospital will operate in only one or more specialized or sub-specialized fields of medicine.
Classification of hospitals in terms of number of beds and areas covered
In the category of inpatient and specialized medical services system of the country, hospitals are divided into the following six levels:
Level 1: Inpatient treatment centers
These centers consist of a health center, maternity facility, laboratory and radiology, pharmacy, and periodic specialized clinic and are managed by a general practitioner. According to the population and regional policies, these centers have the possibility of temporary care and hospitalization of patients for a maximum of 24 hours and are supported by the city's specialist physicians daily and in cycles. In cities where the number of required beds is less than 32 beds and no beds are provided in these cities, a bed treatment center is planned and built to provide the required medical services.
Level 2: City Hospital
These hospitals are the first level of people's access to inpatient services and include at least four main specialized departments (internal medicine, surgery, pediatrics, and obstetrics).
Level 3: District Hospital
These hospitals cover the four main specialties of public hospitals. Also, in cases where the number of beds in a specific specialty to establish an independent ward in the city hospitals has not reached the quorum, the total number of beds in the district hospital of that area is planned as an independent ward. Also, cities that in addition to the four main beds have the capacity for two other specialties, including neonatal and emergency, are included in this type of hospital.

Level 4: Regional Hospital
These hospitals have all the characteristics of a general and district hospital, and also, they are composed of ward beds that have not reached the quorum in any of the covered areas. These hospitals are usually established in provincial capitals.
Level 5: Polar Hospital
These hospitals are the hub of university subspecialty hospitals in several major universities in the country that have various subspecialty services and are responsible for providing services and accepting patients referred to several neighboring provinces.
Level 6: National Hospital
National hospitals are subspecialty and special centers of the country that provide unique and rare specialized services in the country.
Classification of hospitals in terms of mission and main mission
1. Educational Hospital

In this type of hospital, in addition to treating patients, specialists, and medical students are trained. These hospitals should be located near colleges or higher education institutions and have at least 150-200 patients. Also, these centers should be equipped with classrooms, theaters, amphitheaters, seminars, locker rooms, and offices for students and professors.
These hospitals must have a well-equipped medical archive. They should also have special laboratories and radiology and a medical library. The gathering of professors, in other words, the medical elite of each region in the university and the low cost of treatment, is an important factor in attracting patients to such centers. Despite the specialized professors and more complete equipment, many diagnostic-therapeutic operations that are not possible in other hospitals are performed in these centers.
Calculations of the volume of services provided by teaching hospitals are based on the number of students and the educational program of the medical school and general and specialized medical courses.
2. Medical hospitals (non-educational)
Some hospitals only treat and care for patients and do not interfere in the education of medical students. The majority of non-training hospitals are private hospitals.
Locating and selecting the hospital site The location of each urban element in a specific spatial-physical position from the city level is subject to certain principles, rules, and mechanisms. If it is observed, the success and functional efficiency of that element will increase. Thus achieving balance in the spatial distribution of Resources and services are the main goals of planners. In planning, balanced distribution requires location, resources, and facilities In such a way that the covered people can easily benefit from its services. Since the location of the hospital affected Will have a direct impact on the model and its performance, it is important to pay attention to it in different plans and projects; So that the establishment of a hospital in inappropriate places not only will not have the desired efficiency by itself but can cause negative effects on the country's treatment network.

Until two centuries ago, the only effective factor in the construction of hospitals was religious beliefs, the effects of which can be seen so far.
Observed in charitable medical centers. A study of nineteenth-century French hospitals shows that the only difference between hospitals and The churches were only in their name. Therefore, in any part of the city that has received more public assistance, no Examining the relevant factors, such centers have been set up. In Iran, some hospitals, regardless of community conditions and other Influential factors have been created in places that the benefactor wanted, resulting in disruption of the rational distribution system of hospital beds and poor performance of hospitals.
After the Industrial Revolution and the effects of the ideas of sociologists of the time, such as Harvard, the hospital building was removed from the absolute realm of religion and turned from a public charity into a collection for health, medical and educational services.
Eventually, the authorities concluded that the hospital was not a separate and isolated building and that the correct location could make it
A healthy environment for mental and physical relaxation in a social environment.
With a comprehensive view of the existing hospitals in the country, it is clear that some of them, by not observing some basic principles in location, face problems such as difficult and inappropriate access, failure to meet the needs of the covered space, and so on. This will lead to a lack of proper services and patient dissatisfaction.
Therefore, recognizing and identifying the basic indicators and criteria in locating and determining the location of the hospital is very important and should be considered in hospital planning.
General steps of location
Locating medical centers in its broadest sense has two stages:
first stage:
At this stage, which deals with the issue of location with a macro perspective, in general, the location of the hospital is selected based on the country's divisions. Criteria such as morbidity rate, available facilities, population, manpower, economic-cultural and social conditions at the macro level, geographical location (roads and communications), comprehensive planning for the classification and zoning of specialized services, and the formation of a referral network of specialized services In the country, it is one of the determining factors in the location of medical centers at this stage.
second stage:
This stage, which deals in more detail with the category of location, is related to the selection of the exact location of the construction of the medical center in the area determined in the first stage (country divisions). This stage includes physical planning by urban regulations and rules. At this stage, the criteria related to the characteristics of the centers and its external effects or the natural and physical characteristics of the city lands have a decisive role in choosing a specific place for the relevant activity.
In addition to these characteristics, urban features 1 also affect the location process of these centers and its results and will create a special settlement pattern.
Indicators and criteria effective in locating and selecting the hospital site
Some several factors and indicators are effective in locating and determining the location of medical centers and should be in The study and planning stage carefully analyzed and applied to the design of the medical center. At
First, the most basic indicators and criteria are named and then a description of each will be provided:

1. Communication network and access
2. Neighborhood and the principle of neighborliness
3. Development plan and the principle of abundance
4. Infrastructure and infrastructure facilities
5. Economic indicators and the principle of cost estimation
6. Cultural indicators and social psychology
7. Geographical location and climatic characteristics (climate micro)
8. Physical characteristics of lands
9. Land area and dimensions
10. Earth Geometry
11. Types of pollution
12. Passive safety and defense
This section provides tips and requirements for each of these indicators:
Communication network and access
One of the most important issues to consider when locating a hospital is how to access it. In many cases, inaccuracies in the location have led to the possibility of access to the hospital, especially emergency services, with problems and delays, even with the planning and provision of facilities in the hospital. This issue is so important that it can have devastating and adverse effects on the physical or mental condition of patients or even lead to the death of the patient. Therefore, the study and analysis of access routes and communication routes to the site, as well as the study of public transportation around the site and approved urban plans in that area, are the main factors in determining the location of medical centers. Here are some tips in this regard:
1. The capacity of the communication network of the medical center should be appropriate to the area covered by the hospital and by the type, level, and volume of services planned. Thus, the expectations from the service of the center will be determined based on the capabilities and capabilities of the center and in a logical manner. Because the higher the level of a medical center, the more beds, manpower, and its clients will be, so to respond to this volume of traffic, it is necessary to have a relatively wider path around the hospital site. To be. Thus, the higher the level and volume of services of the hospital, the wider the main passage around the hospital should be considered.
2. It should be possible to access it quickly, easily, and relatively evenly from all parts of the geographical area covered by the hospital. In this regard, the concentration of medical centers in specific and limited areas of the city should be prevented. This will cause the principle of distance to be observed in the location of the hospital.
3. In locating the hospital, attention should be paid to future access and communication networks that are foreseen in out-of-plan plans such as a comprehensive plan or detailed plan and its effect on interaction with the hospital should be examined.
4. The possibility of communicating the medical center with other parts of the city through proximity to more than one urban access route and main traffic lines such as highways and main streets should be considered. Otherwise, the above center will not be able to provide services completely and will become an isolated center.

5. The location of the hospital should be on the edge of one of the main and wide streets. The passage adjacent to the main site of the ground where the main entrance of the hospital and the emergency entrance is located is at least 25 meters wide. Also, the passage on the sub-ground, where the entrance of logistics and support, staff parking, etc., is normally located, should be at least 15 meters wide.
6. In case the hospital land is located in the vicinity of the main and fast arteries, it is possible to create a sidewalk and secondary access.
7. The location chosen for the hospital should be close to the public transportation network so that all groups can easily access it. Among them, we can mention the network of subway lines, buses, taxis, etc. If the location of the hospital does not interact with these networks, high costs will be imposed on patients, visitors, and hospital staff.
8. According to the previous paragraph, the possibility of passing underground transportation lines from inside or near the site, as well as proper access to the air transport network can also help increase access and communication with the hospital, especially in times of crisis. Of course, the principle of neighborliness should not be violated in this regard.
9. Hospitals create heavy traffic in the area due to the nature of their activity after the operation. Therefore, factors such as the passages around the hospital, the forecast of parking on or near the site, the forecast of multi-story car parks, the potential of the site in facilitating this traffic, etc. must be carefully analyzed and examined.
10. The access route to the hospital should be away from crowded places and passages as well as urban traffic junctions so as not to disrupt the hospital's services.
11. The route to the hospital should be chosen in such a way as to minimize the amount of disruptive and blocking factors, especially in times of crisis. These factors can include such things as being in the shadow of the destruction of buildings and urban furniture, dense and crowded centers, and so on.
12. A site that can receive more admissions for the hospital is a priority because it is best to separate the main entrances, emergency, and supplies due to differences like their operation so that the best level of service can be presented. It is also important to anticipate routes to continue providing services in times of crisis.
13. In general, the land is suitable for hospital construction, where the main entrance of the hospital is connected to the environment through one of the main streets and is accessible to the traffic of related vehicles such as ambulances, supply vehicles, and fire brigades away from any The type of obstacles are annoying.