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Hospital Planning and Building Standards – AIA, NHS, DIN INTERNATIONAL HEALTHCARE BUILDING STANDARDS & CODES – LATEST ON HARMONIZATION OF CODES AND ACCREDITATION HENNING LENSCH, RRP International Hospital Planners Pte Ltd Munich-Germany-Singapore September 2013

Toronto UIA 2013

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RRP

1. Comparison of AIA, NHS and DIN

2. Case Study 1: planned in accordance with AIA, not acceptable for NHS?

3. Case Study 2: Third Party Review and standards – please re-design?

4. Accreditation and Planning Standards – JCI instead of AIA/NHS/DIN

5. HAAD Abu Dhabi standards, based on Australia hospital standards

6. Outlook and recommendation – what to follow?

7. Question and Answers

Agenda

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1. Comparison between AIA, NHS and German DIN

Agenda

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RRP

AUS SICHT DES KRANKENHAUSES

What is the standard OT seize?

International projects, state of the art?

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1. Standards for hospital operation theatres

Example

AIA: 55 – 60 m2 NHS: 55 m2 Australasian: 42 – 52 m2 Canadian: 48 – 55 – 60 m2 Germany: different standards

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RRP

AUS SICHT DES KRANKENHAUSES

What is the minimum clear door

opening in patient rooms?

International projects, state of the art?

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1. Standards for clear opening in patient room doors

Example

AIA: 1.12 m clear opening Recommendation for clear opening more than 1.22 m NHS: 1.30 m structural opening Recommendation for opening of minimum 1.50 m Germany: 1.10 m clear opening In the average around 1.25 m

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OUTPATIENTS INPATIENTS

Standard for Safety – Standards for All?

The Architect’s Perspective – Clinical Path Ways and Workflow

Economy Meets Humanity

Standard for Workflow and Schedule of Accommodation?

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11 STANDARDS FOR………

Hotel

Nurse-school

Home for dementia

Home for the Elderly REHAB Imaging

Outpatient Department

Public Health Office

Private Hospital Special. Clinics

Daycare Operation Centre

Hospice Health-Park

Phyiotherapy Lifestyle and Spa

Core-Hospital

12 STANDARDS NHS, DIN, NHS and Australasian HFG

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Source: Dr. Ing. Monika Schill-Fendl, Planungsmethodik

AIA, NHS and German regulations

Agenda

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1. National insurance regulations, protection of staff

Germany – different requirements

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1. National insurance regulations, protection of staff

Germany – different requirements

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Design Concept – Staff area

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Design Concept – staff change

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DIN 13080

DIN

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1. Syn-energy for the new hospital

German DIN

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Using the German DIN for schedules of accommodation

Actual location, United Arab Emirates

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Rehabilitation Clinic

250 beds

Ideal distribution of ward area according to Business Planning:

•  V VIP

•  VIP

•  Single

•  Double

•  Clinic Standard (double)

TOTAL

•  All relevant medical specialties and diagnostic equipment •  separated workflow and VIP suites for Medical Check Ups

•  Room categories according to Rehab Clinic

à use guest rooms as overflow for rehab patients

Outpatient Center with Diagnostic

Boarding House/ Accommodation

Mix of Rehabilitation, Outpatient Center and Hotel

# Rooms # Beds

10

20

60

60

20

170

10

20

60

120

40

250

Main sections

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Healing Architecture

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RRP

Using the German DIN for schedules of accommodation

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RRP

NHS example OT

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RRP

NHS layout examples – here OT

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NHS layout examples – here OT

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AIA structure

AIA

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AIA example

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AIA for Cath lab

Agenda

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2. Case Study 1: planned in accordance with AIA, not acceptable for NHS?

Agenda

35

RRP

Comparison AIA and NHS

Agenda

Main difference between US and UK NHS design principles for Cath Lab: In the US (AIA), a dirty utility room is not required to be adjacent to the cath lab room In the US (AIA), rooms for preparation and anaesthesia could be shared and do not have to be adjacent to the cath lab procedure room In the UK (NHS), the cath lab shall have the following adjacent rooms: Anaesthesia, preparation, store room, scrub and gowning and control room.

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RRP

Following AIA, but not NHS

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RRP

1. Syn-energy for the new hospital

Agenda

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1. Syn-energy for the new hospital

Agenda

39 Agenda

Main differences between US and UK NHS design principles for OT: In the UK (NHS), the direct access of the scrub / gowning room, Anaesthetic, Dirty Utility and Preparation room is mandatory In the UK (NHS), the room for preparation is only not needed if the preparation could be done under the ultra-clean canopy in the operation theatre itself In the US (AIA), the ANAE area is the so called “induction room”, and this room could be shared between the OT and also be located not directly adjacent to the OT In the US (AIA), shared scrub zones can be located outside of the OT, in a more or less open zone (ventilation system to be designed in a way that a “air curtain” is more and less prohibiting water from the scrub to come contaminate other areas) In the UK (NHS), separated single room recovery spaces are requested. In the US, a curtain between recovery spaces can be accepted In the US (AIA), the transfer from the patient bed to the OT stretcher could be done in the OT. We do not see any clear requirements / procedure in the NHS guidelines. Here, we can only find the following: “increasing number of patients are transferred onto their beds rather than a trolley. A bed is significantly larger than a trolley.” In the UK (NHS), there are many requirements for the admission lounge, waiting room, administration office as integral to communication base etc. which are more and less referring to very specific workflows and procedures. Here, many of these basic requirements (also for ambulant / outpatient) are not fulfilled and must normally being discussed with the user.

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NHS layout examples – here OT

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AIA extract

AIA for OT

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3. Case Study 2: Third Party Review and standards – please re-design?

Agenda

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AIA Guidelines - Comparison

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AIA Guidelines - Comparison

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1. Is our design wrong?

Third party review according to AIA

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1. Is our design wrong?

Third party review according to AIA

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1. Is our design wrong?

Third party review according to AIA

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1. Is our design wrong?

Third party review according to AIA

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1. Is our design wrong? It is an ICU renovation project……..

Third party review according to AIA

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1. Is our design wrong?

Third party review according to AIA

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1. Is our design wrong?

Third party review according to AIA

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4. Accreditation and Planning Standards – JCI instead of AIA/NHS/DIN

Agenda

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RRP

Hospital Standard and JCI, example

56 Hospital Standard and JCI, example

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5. HAAD Abu Dhabi standards, based on Australia hospital standards

Agenda

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RRP

Further developments of mainly the Guidelines from Australia

HAAD Abu Dhabi

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Further developments of mainly the Guidelines from Australia

HAAD Abu Dhabi

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Further developments of mainly the Guidelines from Australia

HAAD Abu Dhabi

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Further developments of mainly the Guidelines from Australia

HAAD Abu Dhabi

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Further developments of mainly the Guidelines from Australia

HAAD Abu Dhabi

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6. Outlook and recommendation – what to follow?

Agenda

Custom

ers requirem

ents

Workplace design

There is no standard workplace design!

Standards are good, but……………..

Designing for Operational Change

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7. Questions and Answers

Agenda

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Hospital Planning and Building Standards – AIA, NHS, DIN INTERNATIONAL HEALTHCARE BUILDING STANDARDS & CODES – LATEST ON HARMONIZATION OF CODES AND ACCREDITATION HENNING LENSCH, RRP International Hospital Planners Pte Ltd Munich-Germany-Singapore September 2013

Toronto UIA 2013