Photo courtesy: Helix Healthcare Architecture

While the Indian economy has significantly slowed as a result of COVID-19, hospitals are struggling to cope with queues of patients. Their experience has generated interesting learning for the construction industry; in particular, for those planning and designing hospitals.

A big experiential takeaway from the frontline is the need for flexible design.

“Flexibility in design and utility is essential,” says Dr Ankit Thakker, Executive Director and CEO, Jupiter Hospital. “If you plan too tight, you will struggle in challenging moments.”

Flexible design

“Building flexibility into the whole or part of the facility can enable the operational strategy changes needed to cope with a mass calamity,” agrees Rang Emei, Principal, Helix Healthcare Architecture. “Building extra capacity into infrastructure to cope with untoward situations, as is being suggested, isn’t financially viable. Authorities could legally mandate such flexibility, like necessitating that the lobby size to be restructured, or insisting on more than one entrance.”

Jupiter Hospital’s flexibility has emerged from “the inefficient use of space”, to quote Dr Thakker. “Only 50 per cent of our building is revenue-generating; the rest is common areas, corridors, etc. For instance, each of the 110 ICU beds has an associated relative lounge bed with washroom facility, storage area, and phone charging point. During this pandemic, we quickly converted this lounge into a residence for ICU staff who could not go back home.”

“In healthcare, you can’t look at monetising every square inch, which is how a real-estate architect typically thinks,” adds Dr Thakker.

However, most hospitals in cities are congested. They neither permit adequate physical distancing nor hand hygiene, the survival mantras of the current pandemic.

Future spaces

Where will this extra space be used?

In the context of wards, Dr Desai points out that norms specifying at least 4-6 ft of space between two beds will be more strictly monitored.

“Wards may look more like those in hospitals in olden times, which were typically large halls with beds on each side, a toilet block at one end, a nursing station at the other,” points out Dr Desai. “These were called ‘Nightingale wards’ after Florence Nightingale.”

Essentially, hospitals may switch from the current trend of provisioning five-star admitted experiences on the lines of hotels, and segregating patients in wards by gender, and instead create more wards catering to infectious and non-infectious patients, as is the practice globally, adds Major Paresh Singhal, Founder, Eywa Health Infra.

Also, current design guidelines recommend hand-wash basins in every outpatient and inpatient room. However, cost, cultural, practical considerations and, in some cases, even scepticism has come in the way of fully implementing these guidelines, observes Emei.

Standalone blocks

M V Satish, Whole-Time Director & Senior Executive Vice-President (Buildings, Minerals & Metals), L&T, expects COVID-19 to inspire the creation of standalone emergency blocks within the same hospital campus with separate entries for various levels of infections classified into green, orange and red zones. For the main hospital building, he proposes separate circulation routes for infectious patients from their entry to discharge, as well as for staff attending to them.

Ventilation design

“Unfortunately, most hospitals have too few negative pressure rooms, and most of these are scattered across the facility,” says Emei. He expects hygiene and natural as well as mechanical ventilation to become focus areas in future. Possibly, future hospital design could allow for entire wards to be made negative pressure zones if the need arises.

“Building flexibility into the ventilation system would necessitate creating negative pressure isolation capability in infectious disease wards,” explains Dr Desai. “One would also plan for running medical gas pipelines to large waiting areas like dining halls, waiting areas, auditorium spaces and/or parking areas, to be able to provide oxygen supply if and when those places are converted into temporary wards.”

Material palette

“Lightweight modular dry wall systems are more amenable to design changes required for reorganising spaces than brick-and-mortar walls,” adds Dr Desai. “They also facilitate running engineering services like electrical conduits, plumbing lines, medical gas pipes, etc.”

“L&T is using drywalls in ongoing hospital projects,” shares Satish. “Drywalls offer load-fixing strength, robustness, fire safety, strong acoustic properties and impact resistance. With gypsum plastering replacing conventional wet plastering in interiors, project timelines are being reduced even further.”

Satish also recommends the use of vinyl flooring and wall cladding sheets with antifungal and/or antimicrobial properties, and hospital-grade bathroom pods preinstalled with services such as nurse call, electrical lines, plumbing lines, ventilation system and fire protection, coordinated into the pod design to provide conduits, raceways and other spaces needed for the specialty systems, the most crucial of which is the need for a no-threshold barrier for wheelchairs and rolling IV trees. L&T is exploring options to use these pods in some of its healthcare projects to reduce execution time and minimise workers.

Emei expects more anti-microbial finishing materials to hit the market, such as laminates, wall paints and tiles, easily wipeable synthetic furnishing materials and curtains, electrical switches, door handles/knobs, sensor-operated faucets/taps, flooring materials, smart facade glazing systems (which eliminate the need for curtains and blinds to control daylight), touchless electronic access controls and foot/knee-operated electric powered doors.

That’s a lot to look out for indeed!

- CHARU BAHRI

To share your views on Hospital Construction in India post the COVID-19 pandemic, write in at xxxxxxxx

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