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CHAPTER 1

INTRODUCTION

“Every system is perfectly designed to achieve exactly the results that it gets”

. — Don Berwick, MD

1.1 Background of the Study

Children are a group of people who response to environment with all their

five senses; touch, smell, feel, taste and hear. Therefore, during the time of their

hospitalization, health concerns are important parts of the Children's healing

environment and can bring positive outcomes. (Bontile, 201; Rutter, 1981).

The physical, mental and emotional security of children in the medical

industry is an incredibly significant problem. Children's stress from hospital

visits can be further compounded by environmental issues (in this case the term

environment includes all its interpretations; natural, built, interior and outdoor),

colors, textures, materials, scale, and so on.

The political government aims to provide accessible, affordable and equitable

essential health services (Bontile, 2013). Quality of design and thoughtful

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planning of children's healthcare centers can address safety, security and thus the

elimination of their fears, which are important to their health, (Rutter, 1981).

Health care facilities are organizations that have organized medical and other

professional staff and healthcare services 24 hours a day, 7 days a week, (World

Health Organization, 2018). Pediatrics is the branch of medicine that deals with

the prevention and treatment of infants, children and young people from birth

until the age of 18. (Mandal, 2013). Therefore, a Pediatric Center is a child

healthcare facility. Which include: clinics, outpatient care clinics, laboratories,

pharmacies, health and prevention centers, and specialized care health centers,

such as birth health centers, and so on. (World Health Organization, 2018).

The Department of health (DoH) has 1,071 private hospitals licensed and 721

government hospitals. (The Manila Times, 2018). With these, Philippines has

today's children's hospitals, one of which is the National Children's Hospital

situated in Quezon City, Metro Manila. There are 61 current hospitals in Region

VI, Negros, with 5,541 beds producing a bed ratio of 1:1, 328 that is still a long

way from the prescribed new optimal goal of 1:800- bed to population ratio.

(Department of Health of the Philippines, 2015). In the 2016 report released by

the Bacolod City Health Office, the city has one (1) government-owned hospital

and five (5) private health institutions (Bacolod City Health Office, 2016).
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Thus, thorough analysis and understanding of the situations and conditions

are necessary to meet the requirements and needs of the users for their security,

sustainable, and to create spaces within the facility that would be very personal

and user-friendly in a welcoming and comfortable environment. Comprehensive

study and investigation should be done about the region or area to be served so

that appropriate solutions to problems and needs can be determined.

The researcher is very much interested in the architectural design of this

institutional facility that would feed to the demands and necessities of the public

regarding health care.

1.2 Statement of the Problem:

This study aims to come up with an innovative and functional architectural

solution for the proposed Medico Central: A Health Care Facility for Children for

Bacolod City, Philippines.

Specifically, the research needs to answer the following questions:

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On Site Location

1. Where would the suggested Health Care Facility for Children be the most

appropriate and accessible location that would meet the requirements of the

following factors:

(a) Accessibility;

(b) Direct access from the main road;

(c) Distance from other institutions;

(d) Land use in adjoining areas and Zoning;

(e) Existing utilities (water, power, and communication);

(f) Natural forms of monuments, features, views and views?

2. What are the site requirements for the following classifications?

(a) Site strengths

(b) Site weaknesses

(c) Site opportunities

(d) Site constraints/threats

On Site Development

1. What sort of site planning would most suit the facility's effective circulation:

(a) Location of service roads;

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(b) Patient, clients, vehicle, and emergency routes;

(c) Service routes (supplies delivery, waste disposal, and collection,

removal of the dead);

(d) The convenience of the emergency entrance and exits?

2. What will be the most effective arrangement of equipment and amenities in

the field of pediatric care planning?:

(a) Structure orientation;

(b) Slope study;

(c) Landscaping and horticulture;

(d) Future expansion?

On Building Function

1. What will be the number of beds required that are most applicable by the

following factors to the functionality and development of the proposed

pediatric care??

(a) The population of the projected population by age group;

(b) The annual rate of admissions;

(c) Statistics of children cases afflicted with diseases;

(d) Common diseases affecting children;

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(e) The average length of stay in medical facilities;

(f) The range of services;

(g) Target catchment area;

(h) Size of the facility?

2. What are the amenities, equipment and spaces needed for the project with

regards to:

(a) Clinical services;

(b) Administrative services;

(c) Emergency services;

(d) Outpatient services;

(e) Delivery services;

(f) Non- clinical supports (Utilities, maintenance, etc.)?

3. What are planning principles and circulation of the Pediatric care about:

(a) Patient and Staff movement;

(b) Supply delivery;

(c) Disposal of used goods;

(d) Laundry services;

(e) Food services;

(f) Domestic services?

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4. What will be the appropriate planning and design of Pediatric facilities

and departments regarding:

(a) Location (the relationship of spaces to other rooms, services and

departments);

(b) Use (activities carried out in the hall and rooms, number of users

at one time, occupancy or time in control);

(c) Constraints (privacy, supervision, security, separation, fire

protection);

(d) Environment (wind direction; natural and artificial lighting; heat,

humidity, sterility, ambiance);

(e) Sound and ventilation?

5. What will be the strategic solutions to satisfy the user’s and patient’s

experience in the aspects of:

(a) Space and suitability of area;

(b) Privacy and social support;

(c) Comfort, choice, and control;

(d) Variety of experience and access to outdoors;

(e) Communication and information;

(f) Access and way finding (color coding, signage)?

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On Building Aesthetics

1. How will be the design concept and character be relate to the philosophy

of design?

2. What will be the best and most suitable design character to be used in the

project?

(a) Will it help in identifying the function of the facility?

(b) Is it reasonable and realistic?

(c) Will it meet the different hospital planning requirements and

standards??

(d) What will be the concept and idea to be used to improve and

develop the usual perception of hospital design?

(e) Will the design character of the building able to help in the

improvement of the user’s comfort, health, and wellness?

3. What will be the shape and form of the structure?

(a) Is it functional enough?

(b) Is it possible and applicable?

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4. What are the Material Specifications both interior and exterior?

(a) Ceiling;

(b) Floor;

(c) Wall?

On Building Strength and Durability

1. What are the best construction principles and ideas to be used in the

project?

(a) What are the materials and specifications needed?

(b) Will the materials and supplies locally available?

(c) Will it help in the resilience and stability of the building in the

long run?

(d) Are the materials essential and conforms to the standards in

hospital design?

2. Is the building prepared and set for any natural calamity and future

expansions?
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On Building Engineering and Utility Systems

1. What are the innovations that can be used and provided for the

enhancement of medical services in the facility regarding:

(a) Equipment (medical equipment and apparatus);

(b) Lighting and ventilation;

(c) Furniture and fixtures;

(d) Security and emergencies?

2. What are the new things and services the building/ facility can offer?

(a) Is it different from other existing facilities?

(b) Is it necessary and needed?

(c) Does it comply with the standards and requirements of the

facility?

3. What are the necessary utility systems required considerations?

(a) Power Supply (Generators);

(b) Water source;

(c) Plumbing and sanitation;

(d) Sewage and drainage;

(e) Waste management;

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(f) Ventilation;

(g) Fire protection?

1.3 Significance Of The Study

To close the gap between the growing populations is what this study aims

and the need for Medical Facilities, to raise awareness of the diseases that are

affecting the children today, and to design a facility that provides care for

children with common illnesses and with unique conditions.

(a) To the host children and families of the Bacolod City

The healing process can cause stress and make them uneasy, leading in

delayed healing, particularly for the young patients. The spaces within the

facility should be very personal and user-friendly in a welcoming and

comfortable setting to generate a solution to make a healing environment less

frightening.

(b) To the Medical Practitioners

This research may provide a distinct and convenient facility to assist improve

medical practitioners ' efficiency and productivity ; physicians, nurses, midwives,

and other health professionals and employees.

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(c) To the Bacolod City Local Government Unit

This research can be a reference for any future urban developments,

particularly in the health and medical sector.

(d) To The Medical Establishments

The research outcome could be used as a reference in planning to construct a

child-specialized Health Care Facility. In order to attract more individuals, they

could plan a better approach.

(e) To the Researcher

This research can assist and provide familiarity and understanding of the

project to the researcher regarding its impact on the surrounding society and

how the project would help enhance health facilities. It will also assist the

researcher to expand their understanding on designing and planning health

services, government spaces, and healing environment to improve society.

(f) To the Future Researchers

Future researchers would benefit from the studies in collecting information and

data linked to the pediatric (child health care) field.

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1.4 Theoretical Framework

The theories in this study are from famous individuals who contribute and

promote healthy and efficient health care system. These theories will be the

backbone of this research to attain the solutions for the problem.

As to Building Aesthetic

Supportive Design Theory

According to Ulrich's (1991) theory of Supportive Design conceptualizes the

ways “Where the physical-social healthcare environment impacts the well-being of

patients, including stress reduction. The third dimension of environmental

satisfaction sources is the characteristics of interior design. Less continuous

elements of the hospital setting, including furniture arrangements, color and art,

define interior design characteristics.” (Ulrich, 1991).

Sustainable design has an strategy to maximize natural light, add energy

efficiency to decrease expenses and generate cleaner indoor environments. Through

the appropriate design and appropriate details, it is possible to stimulate a welcome

atmosphere of all five senses and make the kid feel more comfortable.
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As to Building Function

Salutogenetic Architecture “Psychosocially Supportive Design”

In healthcare architecture, the word ' Salutogenic ' is frequently used.

Salutogenic design focuses on variables that promote individual health and well-

being and prevent disease. This theory deals with psychosocial research that

attempt to maintain the state of well-being in the belief that disease and health

are different but in the same continuum. (Plowright, 2014)

According to Antonovsky's (1996) salutogenic view focuses on procedures of

health promotion and has become more apparent in the development of new

healthcare structures. The focus is on the physical, psychological and social

health requirements of patients. There is an increasing awareness of the need to

develop ' functionally effective installations which are also human-centered

environments designed to improve and initiate health procedures” (Dilani, 2001,

p. 32).

On Site Development

It is also relevant to salutogenic architecture to combine with the centralized

organization theory that the movement towards the eyes of customers is visible,
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This organization's unifying space is generally regular in form and sufficiently

big to gather a amount of secondary spaces around its perimeter.

According to the Architecture: Form, Space, and Order - 4th edition, 2015 by

Francis D.K. Ching, he explained that a centralized organization relies on physical

proximity to relate its spaces to one another.

“A centralized organization is a stable, focused configuration that involves

some secondary spaces assembled around a large, dominant, central space. The

secondary areas may differ from one another in form or size to respond to

individual requirements of function, express their relative importance, or

acknowledge their surroundings. This differentiation among the secondary spaces

also allows the formation of a centralized organization to respond to the

environmental conditions of its site” (Ching, 2015).

In this investigation, the researcher will apply the advantage of salutogenic

architecture in the design and planning of the proposed Health Care facility for

children or Pediatric car. This innovation will benefit the children and the families

as well as the staffs in their day to day activity around the facility.
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1.5 Conceptual Framework

Paradigm - Fig. 1.5.1

This study is being conducted to present an architectural design of Medico

Central: A Health Care Facility for Children in Bacolod City. With the help of the

six aspects in the study each will be process to come up a good design solution.
INPUT PROCESS OUTPUT
THE SITE
Accessibility to the served THE SITE
community Minimizing distance of
Existing utilities (water, necessary travel, patient-
Power, and communication) THE SITE orientated layout
Presence of natural forms Site observation and
Land Use in Adjoining areas investigation SITE ANALYSIS
Site Land Use and Zoning Able to create with natural
SITE features (such as natural light
DEVELOPMENT SITE ANALYSIS and ventilation). Access to
Site Schematics nature
Landscape and Vegetation
Building Orientation
Efficient arrangement of the SWOT analysis
facilities and amenities: FUNCTION
structure, orientation, slope Create spaces with relation to
study, and future expansion. FUNCTION each other
Area per Person Space control
Space Analysis Comfortable and space
FUNCTION privacy and safety.
Required number of beds, Space Programming
amenities, facilities, spaces,
planning principles and AETHETICS AETHETICS
circulations Applying the building design Stimulate Design Features,
character, concept and theories Complexity and Coherence
AETHETICS in visual form Social support enhancement
Building design character,
overall concept, shape and BUILDING BUILDING
form STRENGTH
STRENGTH
Application of structural design Durable Structural design and
BUILDING analysis and materials materials
STRENGTH
Structural design principles
UTILITY SYSTENS
UTILITY
and material specification
Projection, layout and SYSTENS
installation of utility Durable finishes of utilities
UTILITY SYSTENS for each functional space
Specifications of Materials mechanism
and components
Required engineering and
utility systems
“THIS INCLUDES DATA ANALYSIS
AND LEGAL BASIS SUCH AS
CODES AND LAWS NECESSARY IN
DESIGNING A HOSPITAL”

FEEDBACK
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1.5 Scope and Limitations

 This study aims to seek for solutions in the care of children ageing 18 and

below.

 The study only caters to the population of Children aged 0 – 18 years old in

Bacolod City.

 The aim of this research is to provide a solution for current services lacking

in the health care facilities in Bacolod City for the needs of kids and their

families.

 The research period is expected to cover within four months of research and

collecting data.

 Technical and medical terms are only limited to what is relevant of the topic.

 As to site selection, the site was given by the Bacolod City Planning Office.

 The survey participants are 18 years of age and below who understand the

survey questionnaire and the parents and guardians of kids 6 years of age

and below.
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1.6 Definition of terms

These are the following terms that are used in this study: Conceptually and

Operationally,

Childre’s Health Care

is a hospital which offers its services exclusively to children and adolescents.

Centralized Organization

is a stable, focused configuration that involves some secondary spaces

assembled around a large, dominant, central location (Ching, 2015).

Clinical Laboratory

is a laboratory where tests are done on clinical specimens in order to get

information about the health of a patient as pertaining to the diagnosis, treatment,

and prevention of disease.

Health Care Facilities

is a range from small clinics and doctor's offices to urgent care centers and

laboratories.
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Neonatal

relating to taking care of babies in the first month after their birth.

Pediatrics

is the branch of medicine that deals with the development and care of infants

and children and the treatment of their diseases.

Polyclinic

a dispensary or department of a hospital at which outpatients are treated

Outpatient service

a service in which patients receive treatment without being admitted.

Classification of certain services as ‘outpatient’ varies between hospitals as

similar treatments may require admission in some hospitals but not others.

Segregation

the segregation of sexes. Separation of toilets etc.

Zoning
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Relates to the different areas in a hospital. There are different type of zoning

and these are:

Deep zone are areas that require asepsis to perform the prescribed services:

surgical service, delivery service, nursery, intensive care. They shall be

segregated from the public areas but accessible to the outer, second and inner

zones

Inner zone are areas that provide nursing care and management of patients:

nursing service. They shall be located near the outer zone.

Outer zone are areas that are immediately accessible to the public: emergency

service outpatient service, and administrative service. Located near the entrance

of the hospital.

Second zone are areas that receive work load from the outer zone: laboratory,

pharmacy and radiology. They shall be located near the outer zone.

Service zone are areas that provide support to hospital activities: dietary

services, housekeeping service, maintenance and motor pool service, and

mortuary. They shall be located on areas away from normal traffic.

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Bibliography

Bontile, Honey Loveleen R. (2013). “Performance of DOH-Retained Hospitals in the

Philippines,” no. 2013–36.

Ching, F. D. K. (2015). Architecture, Form, Space, Order. In The effects of brief

mindfulness intervention on acute pain experience: An examination of individual

difference (Vol. 1).

Department of Health, Philippines. (2015). “Philippines’ 2015 Hospital Bed to

Population Ratio.”

Dilani, A. 2001. Psychosocial supportive design —“Design and Health-The

Therapeutic Benefits of design”.

Mandal, B. A. (2013). Pediatrics - What is Pediatrics ? 1–2.

Plowright, P. D. (2014). Revealing Architectural Design: Methods, Frameworks and

Tools. https://doi.org/10.4324/9781315852454

Rutter, M., (1981). The city and the child. American Journal of Orthopsychiatry, V.51

Ulrich R. S. (1991). A theory of supportive design for healthcare facilities. (March).

World Health Organization. (2018). “Hospital”.

Internet sources:

https://www.manilatimes.net/at-a-glance-the-philippine-health-care-system/395117/,

The Philippine health care system, April 26, 2018 The Manila Times