Jan Allen Gomez Hospital Thesis

8/10/2019 Jan Allen Gomez Hospital Thesis

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MAPUA INSTITUTE OF TECHNOLOGY

School of Architecture, Industrial Design, and Built Environment

PROPOSED REDEVELOPMENT OF OSPITAL NG TAGAYTAY:

CREATING THERAPEUTIC ENVIRONMENTS THROUGH

INNOVATIVE HOSPITAL DESIGN

___________________________________________

In Partial Fulfillment

Of the Requirements for the

Bachelor of Science in Architecture

______________________________

Presented by:

JAN ALLEN S.J. GOMEZ

Arch. Junar Pakingan Tablan

Adviser


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CHAPTER I

THE PROBLEM AND ITS BACKGROUND

I.1.1 Introduction

Health is a fundamental right guaranteed by our constitution to all citizens. Health

care, on the other hand, depends on what each citizen can pay. Health inequity is very

evident in our society. The standard in health care for the rich in our country is far

different from that for the poor, and this disparity is growing. The quality of public health

is a major policy issue in every country, whether developed or developing. The

international community, both public and private, also assigns high priority to improving

health conditions in developing countries.

Health facilities are important components of the health care system. The

national government has been aiming for the provision of essential health services thatare accessible, affordable and equitable. Despite the progress cited by the national

government, the countrys public healthcare system is marred with problems. The lack

of health personnel, the absence of adequate facilities, and the remaining barriers for

the poor to access health care are just some of these problems.

Hospitals play a very big role in societys economic and social well-being. Their

healing and rehabilitative functions empower them to bring back a persons productivity

in society. It is very important that the hospital carry out its mission of healing

successfully. Hospitals are designed to not only support and aid safety of patients,

advanced medicine and technology, and quality patient care, but also envelope thepatient, family, and caregivers in a psycho-socially supportive therapeutic environment.

The characteristic of the physical environment in which a patient receives care affects

patient outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction,

and organizational outcomes. The effects can be positive or negative. No environment

is neutral.

Facility designers and health care providers are recognizing the effect of the

physical environment on patient outcomes. Some studies have shown that a facilitys

design can influence the rate of nosocomial infections, errors in patient care, and the

cost associated with treating a given condition. Architects and interior designers whowork with hospitals are becoming increasingly aware of this growing body of evidence

and are taking it into account in their work.


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I.1.2 Statement of the Problem:

The governments health agenda is to provide universal quality health care

to the public. The purpose of this research is to provide a new health facility that can

cater to upgraded services of the hospital with reference to the Department of Health

(DOH) initiatives on regulation and classification of hospitals and other health facilities in

the Philippines. The study aims to create innovations in the design of the new Ospital ng

Tagaytay by incorporating therapeutic designs.

I.1.3 Project Goal:

Design and plan the facilities of the Ospital ng Tagaytay that will meet the

new requirements of the Department of Health classification of hospitals in

terms of services offered and capacity to handle patients

The research aims to explore new solutions in designing and planning

architectural spaces with the therapeutic effects to the patients.

I.1.4 Objectives:

Determine the present and future needs and capacity of the hospital with

regards to the population of the city

Design and plan the hospital that meets the DOH classification by

incorporating spaces to the services added by the hospital to meet the

requirements.

Planning the hospital on the premise of new circulation due to the therapeutic

based design of the facilities.

I.1.5 Significance of the Study

One of the functions of this research is to provide creative and technical

assistance to public hospitals particularly to the Ospital ng Tagaytay. Determining the

current status of the general hospital can help identify the facilities needed to increase


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the service capability and improve the quality of health care of the hospital. The results

of this study can be beneficial in providing recommendations for the redevelopment of

the hospital as a primary health care provider in the city of Tagaytay. It will also serve as

basis for future designs of public hospitals for innovative therapeutic designs.

I.1.6 Scope and limitation

The scope of the research shall be with the bounds of the design of the hospital

and integrating therapeutic environments in the planning and designing of the facilities.

The scope of the study shall also explore new architectural designs, planning of spaces

and study of behavioral circulation of the users in the hospital.

The assessment of the study was limited to 5 years of secondary data. The

limitations of this research are the available applicable designs and technology available

to aid in the healing process. The research is limited to architectural solutions of

integrating therapeutic environments in the design of the hospital. It aims to create and

enhance the design of spaces for therapeutic environments and not meddle with

management and procedural processes in the hospital.

I.1.7 Assumptions

The assumption of this research would be the development of public hospitals

complying with the new Department of Health classification requirements and would

integrate designs for therapeutic environments.


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I.1.8 Conceptual Framework

PROPOSED REDEVELOPMENT OF

OSPITAL NG TAGAYTAY: CREATINGTHERAPEUTIC ENVIRONMENTS

THROUGH INNOVATIVE HOSPITAL

PROBLEM ANALYSIS

METHODOLOGIES

RESEARCH &

CASE STUDIES

CONDUCTING

SURVEYS

GATHERING DESIGN

GUIDE LINES AND

RESTRICTIONS

FORMULATION OF ARCHITECTURAL

SOLUTION

CONCLUSION


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I.1.9 Definition of terms

Accesible- is the degree to which a product, device, service, or environment is

available to as many people as possible.

Healing- is the process of the restoration of health to an unbalanced, diseased or

damaged organism.

Health services- include all services dealing with the diagnosis and treatment of

disease, or the promotion, maintenance and restoration of health.

Hospitals- is a health care institution providing patient treatment with specialized

staff and equipment.

Incorporate - to include (something) as part of something else

Innovation - the act or process of introducing new ideas, devices, or methods Integration - an act or instance of combining into an integral whole.

Patient- is any recipient of health care services.

Psycho-social- means it relates to one's psychological development in, and

interaction with, a social environment.

Rehabilitative- helping to restore to good condition; "reconstructive surgery";

"rehabilitative exercises"

Therapeutic- of or relating to the treatment of disease or disorders by remedial

agents or methods

Quality- the non-inferiority or superiority of something; it is also defined as

fitness for purpose.


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CHAPTER 2

I.2.1 REVIEW OF RELATED LITERATURE AND STUDIES

I.2.1.1 DOH gives hospitals 3 more years to comply with reclassification

The Department of Health and representatives from private hospitals have

reached a compromise that will give healthcare facilities a maximum of 3 years to

comply with the government's hospital reclassification scheme MANILA, Philippines -

The Department of Health (DOH) and representatives from private hospitals have

reached a compromise that will give healthcare facilities a maximum of 3 years to

comply with the government's hospital reclassification scheme.

In a press briefing, Health Secretary Enrique T Ona told reporters the agreement

allows hospitals to beef up their facilities and comply with the DOH's new rules on

hospital classification based on Administrative Order No. 2012-0012."The AO will apply

immediately to new hospitals. For those that are already existing, especially those

without operating rooms, they will be given a maximum of 3 years, but I'm sure most of

them will be able to do it in a year or a year and a half," Ona said. Ona said half of the

estimated Level 1 hospitals under the old ruling need to spend some P10 to P15 million

to put up a decent operating room. This would put them under Level 1 category in the

new classification.

He said that as of 2011, there are a total of 733 government hospitals and 1,088

private hospitals. Presently classified as Level 1 are 771 facilities composed of 372

public hospitals and 399 private hospitals.

The health secretary said he's confident that after 3 years or earlier, more than

half of these Level 1 hospitals would be able to retain their classifications under the new

rules.

Private Hospitals Association of the Philippines (PHAP) President Rustico

Jimenez said they support the DOH's move. However, he said the DOH must help in

fast-tracking PhilHealth payments, which are often delayed, and reaching out to other

agencies on matters that currently hound hospitals.


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Jimenez said one of these agencies is the Department on Environment and

Natural Resources. It has imposed a fine of P200,000 per day for improper hospital

waste management, which, Jimenez said, is difficult for some hospitals that don't own a

waste facility.

"As I said, we are agreeable to those terms because before, our request to

Secretary Ona was that only new hospitals [ought to] be covered by the AO. If you read

the AO, there was no mention of 3 years. After that, Secretary Ona released the 3 years

so I think we are agreeable to that," Jimenez said.

He also expressed the hope that DOH help the PHAP and the Philippine Hospital

Association (PHA) stay as members of the board of PhilHealth. Some lawmakers are

pushing for the removal of the two organizations from the board of PhilHealth on

grounds that their membership creates a conflict-of-interest situation.

New classifications under the new DOH reclassification order:

Level 1 hospitals should have the following facilities:

surgery room

isolation

surgical and maternity facilities

dental clinics

secondary clinical laboratory

blood station

first level X-ray

a pharmacy

Level 2 hospitals require additional departmentalized clinical services including:

a respiratory unit


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high pregnancy risk unit

second level X-ray with mobile unit

Level 3 hospitals should have:

DOH-accredited teaching and training on 4 major clinical services, ambulatory

surgical and dialysis clinics and a blood bank

I.2.1.2 The Healing Environment: A Therapeutic Landscape

There remains so much more to consider in bringing the outdoors inside,

specifically for acute care and other hospital settings.Potted plants became a greater

part of modern life indoors when it was easier to transport them greater distances, and

this also allowed the enjoyment to cross class lines. Passive and active engagement

with nature outdoors can, for example, increase positive affect, reduce

psychophysiological arousal, and renew an ability to perform tasks that require

concentration. This positive affect has transferred itself indoors to the degree that the

access is appropriate and to the extent that the individual is in need of restoration or

stress reduction (Bringslimark, Hartig, & Patil, 2009).

In the late 1960s, when John Portman designed the first Hyatt Regency in

Atlanta, hotels could no longer just landscape their porches and walkways. The

outdoors has been invited indoors almost five decades, with inside offices having

windows and skylights that offer daylight and the hour-to-hour changes in natural light.

By virtue of market pressures to mimic the hospitality industry, and with the emergence

of models of care such as the Eden Alternative for elders, attention to the natural

environment has become a standard of design for care environments. Newer facilities

have gardens, some designed to be actively therapeutic while others to be only

aesthetically pleasing. Some have walkways and security for those residents who may

wander. Other gardens are only to be viewed from outside. What is meaningful and

functional for a long-term care resident who is living in a building is quite different from

an overnight visitor of the acute care patient.


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Questions to consider:

1. How does landscape architecture serve the clinical objectives that drive a healthcare

organization?

2. How can natural landscapes be integrated seamlessly between the inside of a

hospital, which represents illness, confinement, challenge, and fear, and the outside,

which offers health, hope, and freedom?

3. What kind of research would bring to the fore the greater depth offered by landscape

architects to better inform budgetary decisions regarding nature and recovery?

This is the time to tackle these issues, as the values of healthcare organizations

and the inherent stresses placed on patients and staff demand more attention to

humane care. The beauty of nature, by its very character, is therapeutic. Human pain

and suffering can be eased with views that are inherently hopeful, are readily

accessible, offer enough complexity to engage the mind and spirit, and are appropriate

to the needs of the moment. Bringing clarity and skill to how this can be accomplished is

the challenge in front of each of us who works in this field.

I.2.1.3 Patient comfort

Not surprisingly, noise reduction in hospitals is top of mind in hospital facility

design. Some 71 percent of respondents said that over the next five years noise-

reducing construction materials would be incorporated into design features. And 60

percent of respondents said they are incorporating noise-reducing materials into patient

room design. Noise reduction is an area of focus because of the increased emphasis on

patient satisfaction and Facility Guidelines Institute (FGI) Guidelines for Design and

Construction of Hospitals and Outpatient Facilities issued earlier this year that has a

new section on acoustics, including the use of noise-absorbing materials and reducing

the amount of hard surfaces in facilities, which can create unnecessary noise, Sprague

says.The FGI is a volunteer-run organization and its guidelines, published every four

years, are used by 40 states as a hospital licensure requirement. Its amazing how


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noisy hospitals have become, Sprague says.To that point, 71 percent of survey

respondents said that regulatory requirements are a major influence in driving change to

health care facility design. Another FGI guideline involves medication safety zones to

reduce medication errors. This can include guidelines on lighting, security and access,

Sprague says. Nearly half of survey respondents (48 percent) said they would put more

emphasis on medication safety zones over the next five years.Top features in room

design include wireless technology for staff (71 percent), conversion of semiprivate to

private rooms (69 percent), technology integration (65 percent) and bar coding for

medication administration (63 percent).Other items that could influence patient

satisfaction include individual temperature control (59 percent) and patient control of

room lighting and shades (57 percent). Thats a lot, Hamilton says of the results. The

research shows these are helpful in terms of patient satisfaction.An important aspect of

facility design these days is energy efficiency because it can reduce overhead costs,

some experts said. For instance, 68 percent said better energy usage and efficiencies

were a major influence in driving changes in facility design. However, just 37 percent of

respondents said that selecting environmentally friendly materials was a major influence

in design.Energy is the biggest opportunity to make an effect on the financial well -being

of a hospital, says Quirk. It gives you better control over swings in commodities like

gas, water and electricity. Hospitals and health care organizations need to push the

industry and, on the client side, clients need to be willing to take professional

recommendations and step up and take a little bit of a risk.


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CHAPTER 3

I.3 RESEARCH METHODOLOGY

I.3.1 RESEARCH METHODOLOGY DESIGN

In using different methods in the research we can gather different types of data

that can give multiple views of analyzing the research better. Case studies as a method

of obtaining data from the existing site are used by making a detailed study of the

facilities. Different methods of obtaining information like observation and interviews and

consulting with knowledgeable people are used to gain insights on the problems.

I.3.2 RESEARCH DESIGN: CASE STUDY EXAMPLES

I.3.2.1 Childrens Hospital at Montefiore (CHAM) - INTERNATIONAL

The Childrens Hospital at MontefioreCHAM was specifically designed to provide a

healing and aesthetic setting for pediatric care.

Reflects both the philosophies of family-centered care and the teachings of Carl

Sagan, stressing our connection to the larger whole of the universe and making the

hospital a place where the journey is not only towards healing, but also knowledge.

Throughout the hospital, the child is the centerpiece and driving force behind the

design. The concepts of journey and connection are explored on each floor using

different themes and depicted through numerous art installations. Local and nationally

known artists were handpicked to develop each floors pieces around a specific idea

geared either to the developmental level or illness treated on that floor.

These initiatives at The Childrens Hospital at Montefiore (CHAM) and, help

promote well-being among patients, family members and associates by reducing

stressors such as noise, glare and clutter; connecting


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patients and associates to nature; offering beauty and positive distraction through visual

art; and providing space and seating layouts that encourage visitation by family and

friends.

I.3.2.2 St. Luke's Medical Center Global City -

LOCAL

St. Luke's Medical Center - Global City's

wellness-centered infrastructure, state-of-the-art

medical technology and hotel-like ambiance - all

combined to help deliver an exceptional patient

experience.

The exterior of the hospital projects a

modern building with its strong linear elements

and bold horizontal and vertical features. The materials and color schemes gives us an

impression of a state of the art treatment facility.

The hospital tries to inject landscape greeneries

to soften the design and blend well with the

surroundings.

The hospitals lobby is very generous in

terms of space that it can accommodate large

traffic of people going in and out of the hospital.


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The combination of artificial lighting, natural

lighting, and light colored materials gives the

interiors the necessary brightness inside the

hospital to add to a more spacious feel. The

hospitals interior design includeswarm woods

and nature-inspired elements and soft color

schemes.

The width of the hallways of the hospital

are wide enough to accommodate patient traffic

and not cause stress due to congestion inside.

Spaces are located along the corridors to serve

as breaks to the otherwise long pathways. These

spaces tend to serve as lounging areas for people

attending to their hospital needs and services.

The hospital keeps their clinical

departments patients very relaxed as lounge

areas outside of the departments have been

created for the people to use while doing their

business with the clinics. There is ample lighting

in the area to give it a bright spacious feel for the

patients and clients.

The hallways for the doctors offices arealso wide which does not compromise the patient

traffic in the area where consultations are on-

going. The hallways have one side for waiting

areas of the patients for consultations.


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The hallways have vistas overlooking a

pocket sky garden outside so as to give the

passersby visual breaks inside the building. The

hallway uses glass walls as alternative to let

natural light in to brighten up the area where

people can lounge when waiting.

Aside from the vistas provided by the

gardens outside the hospital also utilizes artworks

to serve as visual stimulations for the patients and

people doing their business inside the hospital.

These are one of few strategies of the hospital to

redirect their attention to more pleasant

stimulations of the patients rather than being

stressed with their medical procedures and

businesses.


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I.3.3 RESEARCH DESIGN: CASE STUDY

OSPITAL NG TAGAYTAY

Ospital ng Tagaytay was inaugurated on

April 25, 1997 and was opened publicly on

May 4, 1997. It was dedicated to the people

of Tagaytay as well as nearby communities

to provide primary care as well. The planned

city health center and a lying in clinic was

converted into a hospital and is now the

Ospital ng Tagayaty located at Bacolod St.

Kaybagal South, Tagaytay City, Cavite.

The first time the researcher saw the

hospital from the other side he didnt

immediately think it was a hospital because

of its exterior facade. If not for its signage

that tell you its a hospital you might think its

just another government or private building.

The back of hospitals serves as

parking spaces for their ambulance and

some hospital employees while being

storage for their medical wastes and other

supplies. I immediately noticed the lack of

disposal and storage facility for their medical

waste which is just placed beside the wall

without precautionary coverings or

containment.


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When the researcher looked for the

public toilet in the ground floor the first thing he

saw was the cleaning materials and trash cans

located beside the toilets. There is no visible

storage compartments for these cleaning

materials and the risk of contamination is

evident in the area.

Near the toilet area was a breast

feeding and lactating station and it was near

the exit to the back of the hospital. The air

tanks are just located along the corridor and

there is no storage area than can be located to

safely store the tanks. This is a hazard

considering it is located near the breastfeeding

and lactating area and its waiting area where

patients like mothers and their newborn

children are exposed to these safety hazards.

The hall ways is lit by natural light but can be

only appreciated nearing the exit of the

hallway. The width of the hallway is enough to

accommodate the human traffic of waiting

patients, passersby and some equipments but

on a busy day in the hospital this area could becrowded and become a source of stress

especiall to the patients like the mothers and

their new born babies.


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The laboratory department can only

accommodate one patient at a time in terms of

collecting samples from the patient. When you open

the door you can immediately see the patients chair

with a table for the equipment and materials for

extracting samples from the patients. It is a bit of the

problem for employees and patient traffics since it is

the only door for both laboratory employees and

patients to pass through. A secondary door leading

to the laboratory itself is seen near the patients chair

that could be a hindrance for passersby when there

is an ongoing collection of samples being done.

The laboratory itself is quite small just enough

for making tests that are within their current capability

and capacity.


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The other side of the laboratory is a make shift

storage and equipment area. The space allocated for

the laboratory services is not enough if ever they

decide to upgrade their equipments. The spaces and

furnitures needed to house different equipments and

materials are already utilized.

The internal medicine consultation room and

ob-gyne consultation rooms are housed in one area

where they separated by cubicles inside. The spaces

allocated for these services are limited that the

doctors/ consultant doctors dont have enough room

to conduct proper consultations. The rooms for these

services are not confortable and inconvenient for the

physicians and patients because of the lack of space

and privacy needed for the consultations. Because

consultation rooms are made as cubicles sound

insulation is very poor inside.

The central sterilizing and supply room is the

storage room for the supplies needed in the hospitals

such as fluids, personal protective equipment and

other hospital supplies. It is tha main sourcing facility

for the hospitals materials. Unfortunately the space

for the supplies are almost full and inadequate for


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inventories of certain duration. There is littlee room

to operate for two staff members working inside.

Due to the inability of the central sterilizing

and supply room to accommodate other materials,

the space beside the main stairs has been

converted to a storage facility of Intravenous fluids

(IV fluids) These is located across the supply room

which is a few meters away.

The emergency room is located near the

xray room but some of its facilities are not up to the

minimum hospital standards such as the current

design and condition of the doors. The access of

patients to be confined from the emergency room is

slightly obstructed by the patients waiting along the

Out-patient department clinics. The people waiting

along the corridors is mixed with patients from the

Out-patient Department, patients coming out of theemergency room and even the company of the

patients.

The X-ray room has a very cramped office

space that the desk of the technician and attending

staff is almost obstructing the way where a patient

will pass through. Patient on wheelchairs can have

a stressful time navigating inside the narrow space

going through the room.


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Some of the nurse stations are unmanned

and not well lit so whenever patients within the area

are in need of the attention of nurses they would

have to go to other nurse stations to seek

assistance.

The emergency room is capable of

accommodating from 4-5 patient in its area. But the

problems I noticed is the lack of space for the

equipment. Equipments not used inside the

emergency room are only stored at the sides of in

corners within the emergency room.

Inside the pharmacy office there is no clear

separation for the staff working inside and the

storage areas for the medicines. The spaces for the

storage of medicines are almost full and there is a

need to expand more space to accommodate other

inventory of medicines.


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The counter for the hospital pharmacy is

located at the hospital entrance. In this picture the

counter for the pharmacy is located right beside the

security guard manning the entrance which looks

inconvenient to the patients especially when there is

build up of lines.

People may have a hard time looking for

location of departments inside the hospital because

of lack of centralized maps. They have to depend

on signages on the walls and assistance of

available hospital staff for their way finding inside

the hospital.

Some hallways appear to be dark and not

very well lit with artificial lighting which may

discourage the people from entering the area

because it appears unused.


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Since the hospital is a 2-storey building they

provided a big ramp for transporting the patients to

the second floor where the different wards are

located. Only depending on natural light it appears

to be insufficient for the area which makes it dark.

The hospital administrator says that in an

occurrence of death in the wards there is no other

way to bring down the dead body but to pass

through the ramp which is adjacent to the front

entrance of the hospital and Out-patient

departments. A dead body being taken out of the

hospital passing through these areas is an

unpleasant sight for the patients whenever they are

seeking medical attention in the hospital.

The unused counter was used as a

temporary storage facility for oxygen tanks which is

very dangerous. There should be proper and safe

storage for oxygen tanks and other equipments that

can pose a risk to safety.

The childrens ward offered a playful and

friendly ambiance for the young patients by painting

the walls with recognizable and fun characters to

serve as pleasant vistas.


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The hallways along the wards are dark when they only depend on the natural

light. The colors are plain and comply with the minimal required clean image of the

facility without thinking further of enhancing it to make it more therapeutic.

The single bed patient room was located at the

middle part of the floor of the building. It felt stressful

that the patient is surrounded by the walls of the

hospital without any external access to the

surroundings. The importance of having natural

environments at least to one side of a space can

enhance the therapeutic effects of the hospital.


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The government building does not satisfy the

minimum requirements of the Fire code of the

Philippines in terms of fire exits. From the door used to

the signages there could be more improvement in the

safety of the patients if the codes are followed.

The childrens pediatric department is just near

the entrance and adjacent to the main ramp where in-

patients are brought to the second floor wards. This

poses a risk to the young patients in terms of possible

infections since they are the most vulnerable to

infectious diseases.

The good thing about this space is that

the hospital tried to blend some positive space

in the hospital where the patients can have

pleasant views inside the hospitals and where

people can stay besides from the hospital

areas. The bad thing about this space is that

they did not enhance the potential of this space


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In EmergencyLaboratoryand other

TestsAdmission

PrivateRoom/Ward

Cashier Out

to help the patients and people inside the hospital.

The front grounds of the hospital also serve as the areas for parking for

the visitors. Other parking areas are on the perimeter side of the compound which is not

safe for parked cars.Other parking areas are located on the sideIn emergency cases in

the hospital need to have clear and free from obstruction emergency bays.

InDoctors

Clinic

Laboratoryand other

TestsAdmission

Private

Room/WardCashier Out

I.3.4 Behavioral Analysis:

IN-PATIENT:

IN-PATIENT:


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In Staff AreaAuthorized

Station areasPatients

Room/ WardOut

InDoctors

ClinicPatients

Room/ WardNurse

StationOut

In

Out patientdepartment/

Doctors Clinic

Laboratory andother Tests

Cashier Pharmacy Out

InPatients

Room/ WardNurse

StationPharmacy Out

In Staff AreaNurse

StationPatients

Room/ WardOut

OUT-PATIENT:

PATIENTS COMPANY:

DOCTOR/CONSULTANTS:

NURSE:

OTHER HOSPITAL STAFF:


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I.3.5 Research Instrument: Observation

This technique is used when the data is not adequate through the use of

interview and some other method. Observation used direct means of identifying the

current facility of the hospital, the direct means of observation means of studied the

flow, movement of the people in the facility, the use of the spaces and identifying what

is in the facility. To complete this instrument a Site visit is performed to the potential

research area. We identified the interesting and problematic areas and document the

problem for analysis, and taking it to account, the users and proponents of the area

which is the government and the public.

I.3.6 Research Instrument: Interpritative-Historical


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I.3.7 History:

Ospital ng Tagaytay was inaugurated on April 25, 1997 by former President Fidel

V. Ramos and Atty. Francis N. Tolentino, former City Mayor. This was opened publicly

on May 4, 1997. It was dedicated to the people of Tagaytay as well as nearby

communities to provide primary care as well. The planned city health center and a lying

in clinic was converted into a hospital and is now the Ospital ng Tagayaty located at

Bacolod St. Kaybagal South, Tagaytay City, Cavite. The hospital has the old and new

wards, which houses different sections. Open for 24 hours, it has the strength of 99

competent and well trained staff and consultants. The hospitals commitment is to deliver

affordable, accessible and informative quality health care to their patients, regardless of

sex, nationality, religion, political, affiliation and economic status. They have a vision of

commited patient-oriented comprehensive health care program through pro-active,

effective and humane hospital services.

Ground floor Facilities:

Outpatient section

Laboratory

X-ray

Drug-room/Pharmacy

Records room

Emergency Room

Labor

Delivery room

Eye clinic

Second floor facilities:

Private rooms

Semi-private rooms

Ward Rooms

Authorized bed capacity of 12 beds

but total inventory of 20 beds


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The Local Government Code of the Philippines:

I.3.8 Research Instrument: Qualitative

POPULATION:


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HOSPITALS:


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Local Government Unit- Tagaytay City


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CHAPTER 4

I.4 SUMMARY OF FINDINGS AND ANALYSIS

In this chapter we summarize and analyze the gathered information during the

research methodology phase of the paper. In using the different methodologies to

gather different information about the site and its facilities we are able to systematize

the datas for better anlysis. This chapter will tackles these datas and presentation them

in order to get a picture and further understand the collected information.

I.4.1 PRESENTATION OF COLLECTED DATA

The presentations of data through graphical methods and figures are done in this

study so that the proponent can understand the problem and easily understand the

problem in this study so that the proponent can easily discuss the gathered information.


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Hospital Unmet Bed Need

Projected primary and secondary catchment area (P)201,659

Total Inventory of Hospital beds (IHB)140 beds

Bed to Population Ratio (BPR) = (IHB / P) * 1,000

= (140/ 201,659) * 1,000 = 0.69


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*The standard bed to population ratio is 1:1000 BPR= 0.69 < 1:1000

Projected Bed Need (PBN) = P * (1/1000)

= 201,659 * (1/1000) = 201.65 or 202 beds

Unmet Bed Need (UBN) = PBNIHB

= 202140 = 62Beds

*Based on 2010 Census the projected unmet beds based on the population is 62beds

In computing for the possible increase of bed capacity of the Ospital ng Tagaytay

we shall base it through the Department of Health ratio of bed to population which is

1:1000. Using the 2010 census we computed for the primary catchment area in which

the hospital is located and the secondary catchment area which have access or is

contiguous to the primary catchment area. Following the computation process stipulated

by the Department of Health we were able to come up of the projected unmet beds for

future expansion of bed capacity which is 62 beds. If the Ospital ng Tagaytay shall

increase its bed capacity based on the data they are allowed to add up to 62 beds.


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I.4.2 RESLUTS: INTERVIEW

Ospital ng Tagaytay was originally a city health center and lying in clinic but was

converted to an infirmary hospital. In 2012 the Department of Health (DOH) and

representatives from private hospitals have reached a compromise that will give

healthcare facilities a maximum of 3 years to comply with the government's hospital

reclassification scheme. This agreement allows hospitals to beef up their facilities and

comply with the DOH's new rules on hospital classification based on Administrative

Order No. 2012-0012.

The Ospital ng Tagaytay is currently classified under the General to Level 1

Hospital needing only a Dental Clinic and Blood Station services. 2013 was a good year

for them because of the following achievements that they have done:


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With their achievements, the hospital administrator stressed that their hospital

could have done more for patient care and that if their facilities were upgraded to offer

more services they could not provide. Due to their lack of services they had to refer

other patients to other hospitals that offer services outside of their capabilities.

Transferred Patients 76

Referred indigents to other hospitals 34

Total 110


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These 2013 statistics show the different cases leading up to the morbidity and

mortality of patients in the Ospital ng Tagaytay and the Tagaytay City Health office. The

cases in terms of morbidity and mortality show that the limitations to what the current

level of service the hospital can provide in terms of the treating these cases. Some

diseases need other types of services and facilities that clearly with the present line up

of services and facilities the hospital does not have.

I.4.3 Presentation of the Collected Data: Strengths, Weaknesses, Opportunities

and Threats (SWOT)

I.4.3.1 Analysis of strength of the facilities:

Very accessible to roads either by public and private vehicles

The site of the hospital is located along the Crisanto M. Delos Reyes

avenue traversing the Mahogany avenue and Tagaytay-Nasugbu

highway.

The hospital have some positive spaces

The current design of the hospital incorporated some positive spaces like

the interior garden to boost vistas and lounging areas.

The hospital takes advantage of the natural climate

As part of their savings programs some areas in the hospital takes

advantage of the natural light instead of using artificial ones. The locationof the hospital presents a great opportunity for therapeutic environments

Child friendly ward

The rooms for the childrensward were painted with cartoon characters to

make it a fun and kid friendly ward.


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The 2nd

floor access ramp

The ramp that accesses the second floor is very useful in transporting

patients to their respective wards with its wide pathways and non-slippery

surface.

I.4.3.2 Analysis of weakness of the facilities:

Exterior design

The problem with the buildingsdesign is that it doesnt give an impression

that its a hospital facility. Other than the sign that says itsa hospital it

doesnt convey its purpose to the patients that itsa building of therapeutic

design.

Interior design

Although the hospital meets the minimum requirements for hospital

facilities, the hospital could have exerted an effort in making the interior

design more therapeutic environment for the patients.

Toilet facilities

The number of toilet facilities are not suitable to the amount of users in the

building. Some of the toilets are already dilapidated and in need of

replacement.

The hospital is not friendly to persons with disabilities

The facilities of the hospital lack appropriations for persons with disabilities

such as ramps and toilet facilities for PWDs

No other ramps

The main ramp to the second floor is the only access for transporting

patients. The problem is it crosses paths with the out patient department

and the main lobby that when an unfortunate death of a patient occurs

other patients and visitors will be able to see the body being taken out.

Fire safety code violations


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There are a number of violations in the fire safety code that the design of

the hospital didnt follow and poses a risk in the lives of the people inside

the building

Space allocation and planning

The spaces of the building are not designed for expansion and that when

the administrators plan to add other services to the hospital their only

option is to make a makeshift facility outside of the building.

Lack of landscapes

The exterior of the building lack is landscapes which can help in the

appearance of the building. The only positive space in the hospital which

is the interior garden is not properly landscape.

Lack of lighting

Some areas of the hospital are very dark when natural lighting does not

reach those areas.

Unnecessary noise

The sound minimization or sound proofing in the hospital is not evident in

the areas and it contributes to the unnecessary noise especially when

there are many patients especially children.

In adequate storage spacesThere is a need for more storage spaces especially in hospital materials

and equipment. In some pictures the hospital equipments such as oxygen

tanks are stored along corridor which can pose a risk to the visitors.

Hazardous waste storage facility

The hospital doesnt have any space in the compound for hazardous

waste materials. The wastes were only stored on an open area at the back

of the hospital without any coverings to prevent contamination.


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I.4.3.3 Analysis of opportunities for the facilities:

Due to the growing population in the city of Tagaytay and the adjacent

municipalities there is a foreseen growth in terms of patients in the future.

The Ospital ng Tagaytay is the only public hospital in Tagaytay city and nearby

municipalities which gives it a potential for accepting indigent up to middle class

citizens.

There is a good potential for introducing new facilities adapting with technology

for their convenience.

The hospital is located in Tagaytay city which very well known for its good

climate all year round.

The hospital has a potential to add more beds with the current inventory of bedsof all hospitals there is still an opportunity of growth to increase the bed to

population ratio.

Given the climate and environment of the area there is an opportunity to make

the hospital a more therapeutic environment for the patients.

I.4.3.4 Analysis of potential threat for the facilities:

The age of the hospital is very vulnerable to damages when typhoon Glenda

battered the hospital the roof was damaged and the hospital shut down and did

not accept new patients for almost 2 months. Some patients were transferred.

The current capacity of facilities of the hospital may be inadequate when the

surge of patients come in the near future.

Infections and contaminations of the patients is possible without proper

segregation and protection of their facilities.

Services not found on the current capacity of the hospital may affect its image to

the public as a provider of quality healthcare services.


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I.4.4 Needs analysis:

The facts and figures given in the study is analyzed and gives the necessary

recommendations to what is needed by the facility to satisfy the goals and objectives of

this

The following are the needs of the hospital:

Propose more spaces to add to the current capacity of handling services and

patients.

Propose new spaces for the new services of the hospital to make it a Level 2

hospital

Propose a new exterior and interior design of the hospital that can promote

therapeutic environments to the patients.

Propose new materials that can help further in the goals of the hospitals and

adapt better in the surrounding environment.

A better design of the facilities that is friendly to persons with disabilities.

Injects strategies in the appearance of the hospital to promote a therapeutic

environment.

Design the hospital to make it more adaptive to the current and future climate of

the area.

I.5 CONCLUSION AND RECOMMENDATION:

In this part of the study the proponent clearly identifies the problems of the

Ospital ng Tagaytay to give solutions and recommendations needed to the ailing

problems of the facility.

Based on the analysis of the gathered data, we determined the strength and

weaknesses of the hospitals facilities. We identified the potential risks and

opportunities of the hospital to decide on what the hospital needs. The hospital

needs to increase its capacity to cater to more patients today and in the future. It


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needs more capabilities in handling current cases of illnesses and be prepared for

the future. In its vision of providing committed patient oriented healthcare services

the proponents for the hospital is recommended to subject the Ospital ng Tagaytay

for redevelopment.

In designing of the new Ospital ng Tagaytay strategies must be put in place in

order to make the hospital a therapeutic environment for the patients. In redevelopment

of the new hospital the new facilities must reduce or eliminate causes of stress in the

patients. The new hospital must provide positive distractions and enable social support

to the patient and its immediate families.

There is a good potential for adding more spaces for accommodation of bed

capacities for the growing number of patients in Tagaytay and the nearby areas.

Complying with the Department of Health standards of computing unmet bed

requirements there is still quite a number of beds still needed to suffice the needs of the

primary and secondary catchment populations.

The design of the new hospital must be based on the Level 2 hospital

classification of the Department of health to further enhance its capabilities for current

and potential diseases inherent in the area.


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Part II. Research Focus

In this chapter the emphasis on the main focus of the research is stated

and explored to the redevelopment of the Ospital ng Tagaytay. Principles will be

slated on what is the best approach to the design and how its relevance to the target

market would affect the building.

II.1 Rationale

Proposed redevelopment of Ospital ng Tagaytay : Creating therapeutic

environments through innovative hospital design. In this part of the research we shall

focus on innovative approaches in design to create a therapeutic environment for the

users of the hospital. Many studies are linking the hospital environment to healthcare

outcomes, buildings can either make a people sick or help them heal. The Ospital ng

Tagaytay is committed in providing affordable, accessible, and quality healthcare to

their patients. Their mission and vision is to providing quality healthcare services

through patient-oriented facilities and services. By adapting national and

international standards of hospital design and injecting new innovations, the new

Ospital ng Tagaytay aims to promote a reliable, modern and therapeutic

environment for their users. This research aims to show the potential of the hospital

of reaching more patients in the city and neighboring municipalities but also also

expand it capabilities of providing healthcare services to their patients.

II.2 Principles and Relevance to the Project

Therapeutic Environment theory stems from the fields of environmental

psychology (the psycho-social effects of environment), psychoneuroimmunology (the

effects of environment on the immune system), and neuroscience (how the brain

perceives architecture). Patients in a healthcare facility are often fearful and

uncertain about their health, their safety, and their isolation from normal social

relationships. The large, complex environment of a typical hospital further


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contributes to the stressful situation. Stress can cause a person's immune system to

be suppressed, and can dampen a person's emotional and spiritual resources,

impeding recovery and healing.

Healthcare architects, interior designers, and researchers have identified four key

factors which, if applied in the design of a healthcare environment, can measurably

improve patient outcomes:

Reduce or eliminate environmental stressors

Provide positive distractions

Enable social support

Give a sense of control

II.2.1 Principles: Noise Reduction

There are two main reasons why hospitals are noisy. First, there are many

noise sources present, and, second, environmental surfaces in hospitalswalls,

floor, and ceilingtend to be sound-reflecting rather than sound-absorbing.

Sounds contributing to the loud noise levels in hospitals come from mechanical

equipment in usealarms, paging systems, telephones, computer printers, ice

machines, staff conversations, and noises generated by roommates and visitors.

Many studies have found that staff conversation in particular is a major source of

loud noises on the hospital unit. The presence of hard sound-reflecting surfaces

in the hospital tends to aggravate the noise problem in hospitals. Sound-

reflecting surfaces cause noise to propagate considerable distances, traveling

down corridors and into patient rooms, and adversely affecting patients and staff

over larger areas. Sound-reflecting surfaces typical of hospitals cause sounds toecho, overlap, and linger or have long reverberation times Reverberation is the

persistence of sound in an enclosed space, resulting from multiple reflections

after a sound source has stopped. Extensive use of sound-absorbing material will

mean that the sound is absorbed and, thus, prevented from building up. When

acoustic conditions are characterized by long reverberation times, echoes will


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cause blending and overlapping of sounds, resulting in reduced speech

intelligibility. To make themselves heard staff members then need to raise their

voices, thereby compounding the noise problem even further.

II.2.2 Principles: Access to Daylight

At least 11 strong studies suggest that bright light is effective in reducing

depression among patients with bipolar disorder or seasonal affective disorder

(SAD). A majority of the studies have examined the impact of artificial bright light

in reducing depression. Artificial light treatments usually range between 2,500 lux

and 10,000 lux. The treatment is believed to be effective by suppressing the

onset of melatonin. Two studies have shown that exposure to natural bright light

is similarly effective in reducing depression. Benedetti and colleagues (2001)

found that bipolar depressed inpatients in east-facing rooms (exposed to bright

light in the morning) stayed an average of 3.67 days less in the hospital

compared with similar patients who stayed in west-facing rooms.

Exposure to daylight reduces depression among patients with seasonal

affective disorder and bipolar depression. It helps decreases length of stay of

patients in hospitals. It also improves sleep and circadian rhythms and lessens

agitation among dementia patients, ease pain.

Lighting in healthcare settings

Provide windows for access to natural daylight in patient rooms, along with

provisions for controlling glare and temperature.

Orient patient rooms to maximize early-morning sun exposure.

Assess adequacy of lightinglevels in staff work areas.

Provide high lighting levels for complex visual tasks.

Provide windows in staffbreak rooms so staff has access to natural light.


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II.2.3 Principles: Artificial Lighting

The lighting of hospital tasks is important as is the lit appearance of the

interior. There can be a conflict of requirements. On the one hand, there are high

technology and critical tasks, some of which can have life or death implications.

This suggests a crisp high-tech appearance, which will stimulate staff to a high

level of performance. But on the other hand, the patients, particularly as they

recover, may require a softer approach bordering on a domestic impression.

This same sort of conflict is shown in entrance and reception areas. The

patient or visitor arrives wanting reassurance about the quality and care level of

the hospital.

This can be demonstrated by the quality of the interior design, which

includes the way the space is lit. But they also need to have clear direction to the

reception desk, perhaps by making it the brightest part of the scene; here they

are welcomed and directed to where they need to go next. If the lighting scheme

is well designed, some of the apprehensions will be alleviated. Also if they have

to wait in an unappealing space where the lighting has a functional appearance,

they may become agitated and restless a state unhelpful for a medical

consultation or examination.

II.2.4 Principles: Postive Distractions in Hospitals

When people refer to their healthcare experience, they typically (and

correctly) note their experiences in the examination, treatment, and recovery

rooms as well as interactions with the caregivers and support staff. However, it is

common knowledge that a sizable proportion of a patient's and the

accompanying family members' time are spent waiting. Today's planners are

paying considerable attention to waiting time as well as waiting spaces. After all-

from a lean process perspective-any waiting time is a waste that should be

purged from the system. While a wait-free healthcare model does not exist, the


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time people spend waiting is increasingly being acknowledged as a crucial

aspect of the overall healthcare experience, with a general appreciation that the

waiting period is not the best part of the healthcare experience for patients and

families.

Studies are providing more information on the waiting experience. A 1996

article, published in the Annals of Emergency Medicine, reported that it is not the

actual wait time, but the perception of wait time that is the determining factor in

patient satisfaction. The International Journal of Research in Marketing

subsequently reported that the attractiveness of the waiting environment has a

greater role in contributing positively to the waiting experience, as compared to

reducing the objective waiting time. A 2008 report from Cornell University further

articulated the potential association between the quality of the waiting

environment, the perceived waiting experience, and the overall healthcare

experience. Sets of independently collected data on environmental attractiveness

and a host of perception measures from actual patients in six clinic waiting areas

demonstrated significant correlations between the attractiveness of the physical

environment and perceived waiting time, perceived care quality, level of anxiety,

and quality of interaction with staff.

II.2.5 Principles: Enable Social Support

Patients and visitors often perceive hospitals as scary, intimidating, and

isolating places. Aside from uncertainties associated with illness, aspects of the

hospital environment itself may generate feelings of uneasiness and heighten

stress levels.

Providing patients with social support can lessen stress, reduce

fear/anxiety, improve outcomes, and stimulate healing. Specifically, Social

support may reduce the amount of medication required, accelerate recovery, and

facilitate compliance with prescribed medical regimes. Providing patients with

social support may also help patients take their mind off of their serious medical


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conditions and promote feelings of usefulness. Plus, family-centered spaces are

associated with decreased length of stay, fewer medication errors, and fewer

falls. In conclusion, the presence of family and friends during hospitalization is

beneficial to the patients physical, social,emotional, and mental well-being.

II.2.6 Principles: Colors

It has been suggested that color has a therapeutic effect, although few

empirical observations exist. From daytime to night-time and through all seasons,

the colour of theinterior needs to be attractive and relaxing without being too

stark. The selection of colours for this area is not easy, as all colours will have to

be tested under the light sources installed or planned to be used in this sector of

the building. Some beige or neutral tones can take on very unattractive green or

orange hues under different types of lighting. What appears to be a very soft and

neutral decor by day can turn into an unpleasant colour at night.

II.2.7 Principles: Landscaping

Findings from several studies of non-patient groups suggest that even

brief visual encounters with real or simulated natural settings can elicit significant

psycho-physiologic restoration within as little as 3 - 5 min. This restoration is

manifested as reduced negative effects, and heightened positive effects and

changes in physiology systems that are indicative of reduced arousal or stress

mobilization (electrocortical, cardiovascular, neuroendocrineand

musculoskeletal). Accordingly, Sherman et al. focused on the activities of the

users in the hospital, and found that 66% of staff garden usage was in the form of

walk-throughs from one place to another. Although this activity does not fullyexploit the gardens to their full capacity, research such as Kaplans on micro-

restorative experiences suggests that even these brief encounters may enhance

staffs well-being and job satisfaction, both of which are predictors of patient

healthcare satisfaction.


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II.2.7 Relevance Therapeutic environments in the hospital: Ospital ng

Tagaytay

The relevance of applying therapeutic environments in the design of

hospitals is to create environments where the patients experience an wholistic

care of mind and body. Aiding the pschiatrical therapy with physical treatment of

the patients increases the effectivity of hospital treatments. The Ospital ng

Tagaytay is committed to a patient-oriented healthcare by providing a

comprehensive approach through innovative, pro-active, effective and humane

hospital services.

The hospital aims is to further expand its capabilities and capacities in

providing healthcare to its users. This is a perfect avenue to introduce new

strategies in trying to connect the link of the physical environments to the patients

welfare.

In trying to achieve a therapeutic environment for the patients the design

of the hospital focuses on the factors that give stress to the mental and emotional

state of the patient. Designing the external and internal environments of the

hospital to promote therapeutic effects to the patient can increase ones success

of getting well from an ailment.

II.3 APPLICATION OF THE PROJECT.

II.3.1Exterior Design

Hospitals designs are not commonly known for pleasure mostly because

people visiting this type of building are seeking for medical treatment. Normally,

hospitals are very simple and minimalist in design, either: we think of over-lit and

sterile environments, with visual stimulation limited to small, wall-mounted

televisions.


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However, a new generation of medical facilities is changing the face of the

hospital design. These places take a more holistic approach to healthcareone

that takes the therapeutic environment into consideration. As a result, hospitals

are becoming more welcoming and diverse than those with which many are

familiar.

The design of the Ospital ng Tagaytay tries to be a contemporary building

for its medical facilities when it was first built by the proponent. However in

todays changing design of hospitals it cannot keep up with the new trends in

therapeutic environments. The facade of the building is probably the most

important part of the hospitals appearance as it immediately gives the impression

of what kind of services a hospital can give. By applying new trends in hospital

design and materials they can already set the tone to the prospective patients

that the hospital is state of the art with patient-oriented facilities offering

therapeutic environments to the people.

The design of the hospital must work with the environment that it is in.

Tagaytay is situated in a high area and the climate is appeling almost all yearlong. Applying modern tropical architecture to take advantage of the climate in

the area could help both the hospital administrators and the patients in reaping

the benefits of the good weather in the area. Modern materials such as glass and

wall panels/cladding are a welcome addition to the exterior design of the hospital


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as it offers a fresh look to the building. Using stainless or rust resistant materials

are recommended in the buildings materials because of Tagaytays cold climate.

II.3.2Noise Reduction

Research suggests that environmental interventions may be effective in

reducing the noise levels in hospitals and improving the acoustical environment.

Key interventions include installing high-performance sound-absorbing ceiling

tiles, eliminating or reducing noise sources, and providing single-bed rather than

multi-bed rooms

Sound-absorbing ceiling tiles

At least three studies have shown that installing high-performance sound-

absorbing ceiling tiles and panels results in reduced noise levels and perceptions

of noise and impacts other outcomes such as improved speech intelligibility and

reduced perceived work pressure among staff. Though decibel levels were not

greatly reduced as a result of the ceiling-tile intervention in these studies

(reduction of 3 to 6 dB(A)), reverberation times and sound propagation were

significantly reduced. This impacted the perception of the unit being less noisy

and also improved speech intelligibility, which has implications for staff

communication.


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Reducing noises from floors

By far the most effective way to reduce impact noise from above is to lay

carpet with thick padding underneath the thicker, the better. This dissipates

the impact energy before it has a chance to enter the building structure as sound.

Carpeting gives superb results and often resolves the problem of impact noise.

Resilient Underlayment with Damping Compound If you have impact noise

but carpeting is not feasible in your case, or is something you'd prefer to avoid,

then you'll want to put down layers of flooring that include resilient underlayment

and damping compound. The resilient underlay introduces a decoupling effect,

and the damping compound further dissipates the sound energy, and is

especially important at lower frequencies where underlayment does not help.

You will also have the opportunity to choose materials that provide

additional mass, introducing a third soundproofing element that is especially

important if airborne noise (such as voices or music) is also a concern. (If your

existing subfloor is already substantially massive, such as a concrete slab,

adding additional mass will not accomplish much and won't be necessary.)

Resilient Underlayment: There are several varieties of resilient

underlayment material available, including foam, fiber, cork, and rubber. A

shredded rubber mat is an excellent choice because it is heavier than foam or

cork, so it gives you the extra soundproofing benefit of added mass.

Damping Compound: The damping compound (typically Green Glue Noise

proofing Compound) can often be applied directly onto the existing subfloor layer,

if the subfloor is not thick and massive, and it is of a material that can be screwed


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into. Since the damping compound needs to be between two stiff surfaces to do

its job, a rigid layer needs to be placed above it. You can use cement board, or if

total thickness is not a concern and you want the extra mass for more sound

isolation, you can use thicker sheets of medium-density fiberboard (MDF) or

oriented strand board (OSB). Any sheets that have damping compound between

them should then be screwed together.

Flooring: Install your choice of finished flooring (such as hardwood, wood

laminate, or tile) on top of the underlayment as a floating raft in other words,

do not attach it to the layer beneath with nails, screws, or adhesive. Also, leave a

gap between the edge of the flooring and each wall, and fill the gap with acoustic

sealant. This gap allows for expansion of the flooring, and also acts as a

decoupler, helping reduce the sound energy that is transmitted through the walls

into the building structure (the "flanking noise" problem).

II.3.3Artificial Lighting System

Reception Areafixed downlights are used for general lighting. To guide

visitors to the reception area, accent lighting is used to illuminate the back wall,

whilst suspended luminaires are used for task lighting above the reception desk.

In daylight areas, daylight regulation is used to save energy by using a daylight

sensor.


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CorridorsA space where patients often meet each other and talk while

navigating their way through different parts of the hospital, this solution for

corridors in hospitality areas features LED lighting. It ensures that lighting brings

high efficiency in terms of guidance, safety and comfort, while at the same time

having diffused lighting without glare.

Lighting plan


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Waiting RoomIn this standard lighting solution, contrasts are creared to

stimulate interaction between people and to give the waiting area a friendly

dynamic. This has been achieved by the use of downlights. Where the luminaires

are placed near the wall, a pleasing play of light beams is visible.

Lighting plan


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Examination Room In an examination room accurate color rendering in

the lighting is of vital importance. This standard lighting system can be adjusted

to suit the activity whether calming, to assist with patient conversations or

brighter task lighting for examinations. Different presets for different lighting

levels can be pre programmed and this scheme includes an additional LED

examination light, featuring high color rendering with no heat output.

Lighting Plan


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Imaging room this room uses LED downlights that provide effective

general white light with very low energy consumption. In additions the system is

fully dimmable using DALI controls and this solution provides a very comfortable

feeling in the imaging room

Lighting plan:


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Patient Roomto create a comfortable and warm ambience, a luminaire

with a gentle light and soft appearance has been selected to meet the needs of

patients and comply with requirments for patient rooms. In addition, there is a

wall mounted reading light which can be controlled by the patient. In the

evening, a downlight above the table makes the space more open and inviting for

visitors, plus an additional task light is provided above the table.

Lighting plan:


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II.3.4 Accessing Daylight:

Access to sunlight will depend on window orientation and on

overshadowing by obstructions. In general, spaces lit solely by windows facing

within 45 degrees of due north will be perceived as poorly sunlit. Windows within

90 degrees of due north are also likely to give little sun if there are significant

obstructions to the south. For many low-dependency hospital spaces, curtains

are the common shading option. Metallized fabrics are available which can reflect

extra solar heat to the exterior and provide some extra insulation at night. For

maximum daylight, it should be possible to pull the curtains fully back so they do

not obstruct the glazing. Louvered blinds give better control of sunlight; often the

blind can be adjusted to block sun but permit some view out. They are harder to

keep clean, but provide good glare control, especially in non-clinical areas. The

most hygienic option is to use mid-pane blinds in a sealed double-glazing unit.

Mid-pane shading also rejects more solar gain than an equivalent interior blind.

In spaces with significant window area, extra shading may be required to prevent

overheating in summer. Horizontal shading above the window, such as awnings,

overhangs or canopies, can block high-angle summer sun while allowing winter

sun and a view out. High performance glazing is now available which can give

reduced solar transmittance with a higher daylight transmittance.

Sunlight in outdoor spaces around the hospital is also valued, both for

sitting out and to give pleasant views from inside. Asked if they would prefer a

pleasant sun-lit view with no indoor sun rather than indoor sunshine with an

unpleasant view, 50% of patients opted for the view. Courtyards, particularly

deep ones, are generally poorly sun-lit unless they are opened out to the south.

Lighting in healthcare settings

Provide windows for access to natural daylight in patient rooms, along with

provisions for controlling glare and temperature.

Orient patient rooms to maximize early-morning sun exposure.


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II.3.5Positive distractionsinside the hospital

Positive distractions refer to a small set of environmental features or

conditions that have been found by research to effectively reduce stress.

Distractions can include certain types of music, companion animals such as dogs

or cats, laughter or comedy, certain art, and especially nature. The focus here is

on the last, nature.

Design strategies in providing positive distractions inside the hospital are the ff:

Views of nature, from patient rooms, and wherever possible in lobby,

waiting, and other 'high stress' areas

Access to nature, healing gardens Chapel, meditation room, and

meditation gardens

Artwork depicting nature, including back-lighted photographs of nature

Mild physical exercise; corridors, public spaces, and gardens that invite

walking when appropriate

II.3.6Enabling social support:

Many studies have demonstrated how social support can improve health

related outcomes. Studies have shown a general positive association between

the overall number of social ties or contacts people have and their health status.

Research has shown that in a range of healthcare and non-healthcare settings,

people who receive higher levels of social support, tend to be less stressed and

have better health status than more socially isolated people.

Design strategies that promote social support are the ff:

Spaces should be flexible and easily controlled by patients and families

in order to adjust to situational needs.


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Provide patients with single rooms, with designated family areas

Provide family lounges and waiting areas near patients


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Create a confortable environment by incorporating soft finishes,

furnishings and materials into the design.

Use technology to foster social support

Provide natural gardens for patients and families to use


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II.3.7 Therapeutic effects of Colors

A perfectly crafted color palette can do wonders for a healthcare facility,

whether its the product of a new-build project, renovation, or just a bit of

rejuvenation.

But determining what shades of paint are best suited for a specific space should

be done with plenty of consideration for not only facility type, but also the

area/department being painted and the individuals who will be using it.

White walls are often associated with a clinical appearance and

institutional settings. Adding color and an interesting ceiling design, as

in this procedure room, can make the environment seem less

intimidating.


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Color may be tied to the institutions logo or corporate brand

Art can create an analogous color scheme in hospitals


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Here several colors of various hues, but similar in value,combine to

create a warm environment and visually shorten a long corridor.

Signage is sometimes overused in healthcare.Small accents of color

may play a role in attention grabbing assisting as a wayfinding cue.


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II.3.8 Landscaping

Landscaped grounds - Green areas between buildings, primarily used for waiting

and eating in, link the architecture with walking paths; however, they may be

expensive to maintain.

Landscaped setbacks - These are usually planted areas in front of the main

entrance, which are visually pleasant and serve to separate the hospital building

from the street.


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Courtyards - Courtyards are the central and most often used spaces in a hospital

building complex, because of their proximity to the dining area; they tend to be

used more by visitors and patients if they are easily visible, and should be

sufficiently large to prevent overcrowding. Courtyard features may include

landscaped tree-shaded areas, water features, flowerbeds and moveable seats;

for reasons of privacy and security as well as aesthetics, they may be fenced

around (especially if designed for care of the mentally ill) up to a height of 4.27m.

Roof gardens - Gardens located on roofs are visually attractive, enabling

patients to look out from their rooms and have a comforting view of grass,

paving stones, benches and people, rather than roofing material or medical

equipment. Depending on how much planting material is used and to what depth,

green roofs generally weigh between 6.82kg and 22.73kg per square foot. They

are a practical and sustainable way of regulating the quantity and speed of run-

off, as they retain 70-90% of the rainwater that falls on them in the summer, and

35-40% of the precipitation in winter [18]. Roof gardens enable major energy

savings that will more than compensate, in time, for the costs of building,

structure, waterproofing, and landscape maintenance; and they also minimize the

environmental impact of a health care facility.


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Viewing gardens - Some health care facilities with limited space and budgets

feature a small, enclosed garden that can be seen but not entered. Such gardens

cost little to maintain, provide some green space, flowers, perhaps a water

feature, and they can be seen from sheltered indoor seating areas; however, the

elements of nature they provide are removed from the senses, as they cannot be

approached smelled, heard or touched.

Part III Site


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Identification and Analysis

Chapter III.1 Site Evaluation and Analysis

III.1 Criteria for site selection

In this chapter, the site of the Ospital ng Tagaytay is being analysed and identified, the

characters of the site based on the progression and undesirable characters are being

identified in terms of the macro setting and micro setting. Specific laws and ordinances

are stated according to the particular area.

III.1.1 The Macro Setting

Location of Site

Tagaytay, officially the City of Tagaytay is a component city in

the province of Cavite, in the Philippines. It is one of the country's most popular tourist

destinations because of its outstanding scenery and cooler climate provided by its high

altitude. Tagaytay overlooks Taal Lake in Batangas and provides one of the iconic

views of the Philippines, the view of Taal Volcano Island in the middle of the lake,

viewable from several vantage points in the city.


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Boundaries of Tagaytay

Tagaytay is relatively close to the capital city of Manila, only 55 km (34 mi) away

via Aguinaldo Highway, providing an easy escape for the locals from the heat of the big

city.

Tagaytay City has a total land area of 66.1 km2(26 sq mi) which represents about

4.37% of the total area of the Province of Cavite. It lies within 120 56' longitude and 14

6' latitude and overlooks Manila Bay to the North, Taal Volcano and Lake to the south

and Laguna de Bayto the east.

III.1.2 Land Area

Land Capability Map


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The southern and eastern portions of Tagaytay City are covered by hills and mountains

which is generally forests and open grasslands. The city lies along Tagaytay Ridge,

a ridge stretching about 32 kilometres (20 mi) from Mount Batulao in the west to Mount

Sungay (now People's Park in the Sky) in the east with elevations averaging about 610

metres (2,000 ft) above sea level.

Mount Sungay, in Tagaytay, is the highest point of theprovince of Cavite at 709 metres (2,326 ft).

III.1.3 Topography

Soil Suitability Map

The ridge, which overlooks Taal Lake in Batangas province, is actually the edge of Taal

Caldera. The 25-by-30-kilometre (16 mi 19 mi) wide cavity is partially filled by Taal

Lake.[6]Tagaytay's built-up areas including the urban center is situated in the relatively

level top of the caldera rim but beyond the edge are deep ravines that drop straight

down to Taal Lake. The portions adjoining the municipalities

of Mendez, Indang, Amadeo and Silang are level to nearly level areas interspersed withvery gently sloping surface. Across the southern edge of the lake on the opposite side

of the city is Mount Macolod, the highest point of the Taal Caldera rim.
http://en.wikipedia.org/wiki/Tagaytay#cite_note-6http://en.wikipedia.org/wiki/Tagaytay#cite_note-6http://en.wikipedia.org/wiki/Tagaytay#cite_note-6http://en.wikipedia.org/wiki/Tagaytay#cite_note-6


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Amended Land Use Plan

Access Road Map


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III.1.4 The Micro Setting

Site Location

The site of the current Ospital ng Tagaytay is located on Tagaytay City, near the

Tagaytay City Hall. The site is along Crisanto M. Delos Reyes Street which jeepneys

pass through.

Property Identification Map


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Referring to the figureThe site of the Ospital ng Tagaytay is located on Lot 011 which

has an area of 1000 Sqm is adjacent lot 013 having an area of 3722 Sqm. The

redevelopment of the Ospital ng Tagaytay will involve the construction of a new building

which will be erected on lot 013.

Traffic and Noise Analysis

Traffic Analysis

Jeepneys pass along road Delos Reyes (Yellow Line) and so the main traffic is

along this road only. Private vehicles barely pass through this part unless their purpose

is to go to the hospital or to the city hall. The main traffic passes through Tagaytay-

Nasugbu Highway which is connected to Delos Reyes Street. Since the hospital and the

site is along a road that is passed by jeepneys, it can be expected that the site is

exposed to a lot of noise from the eastern side.

The immediate vicinity of the site is clear and of open spaces and so there is not

much activity around. Foot traffic therefore is also to a minimum unlike the vehicular

traffic on Delos Reyes Street.


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Sun Path Diagram

Wind Path Diagram


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III.1.5 Related laws and ordinances

ZONING ORDINANCE for TAGAYTAY CITY

CITY ORDINANCE NO. 97-93 Series of 1997

AN ORDINANCE REVISING THE ZONING REGULATIONS FOR THE CITY OF

TAGAYTAY, PROVIDING FOR THE ADMINISTRATION, ENFORCEMENT AND

AMENDMENT THEREOF AND FOR THE REPEAL OF ALL ORDINANCES IN

CONFLICT THEREWITH. Be it ordained enacted by the Sangguniang Panlungsod of

Tagaytay that:

WHEREAS, the implementation of the Comprehensive Land Use Plan would require the

enactment of regulatory measures to translate its planning goals and objectives into

reality; and a Zoning Ordinance is one such regulatory measures which is an important

tool for the implementation of the Comprehensive Land Use Plan;

WHEREAS, Republic Act No. 7160, otherwise known as the Local Government Code of

1991 authorizes local government un

Jan Allen Gomez Hospital Thesis

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