Healthcare Buildings Research Articles

Establishing a breast cancer center in Herat, Afghanistan: an implementation study

ObjectiveBreast cancer is the most common cancer in women, causing significant mortality in the world, which contributed 11.7% to the overall cancer-related mortality in Afghanistan. In 2018, 3 062 new breast cancer cases were reported accounting for 29.7% of all cancers in women in the country. However, a comprehensive diagnostic and therapeutic system is lacking in Afghanistan. In this paper, we reported the implementation of a project aiming to establish a comprehensive breast cancer center in Herat province of Afghanistan. MethodsFrom July 2017, a two-year-program initiated at Kimia Hospital in Herat. This first free diagnostic and therapeutic breast cancer project planned by the Afghanistan Surgeons Society – West and the Verein für Afghanistan-Förderung e. V., as well supported by three international foundations. The target populations of this project were women presenting with breast problems at Kimia Hospital in Herat and healthcare staff involved in breast cancer diagnosis and management. ResultsA group of six medical personnel chosen to represent the breast cancer core team for breast cancer diagnosis and management were trained in India. These caregivers established the breast cancer service and tumor board. During a period of 20 months, a total of 632 women with breast problems presented to Kimia Hospital of whom 44 (7.0%) were diagnosed with breast cancer. Diagnosis was established by a physical examination, ultrasonography, mammography, biopsy and histopathology. Treatment included surgery, radiotherapy and chemotherapy. Twelve seminars for 512 healthcare workers, 1 000 brochures and a movie were prepared for awareness-raising actions. For continuation of this project, potential resource providers were identified. A database was developed to record project findings. ConclusionImplementation of this comprehensive breast cancer project resulted in significant achievements in healthcare staff capacity building, diagnosis and management of breast cancer patients in Herat province. Data obtained in this project offer Afghan government, public health authorities, and the community the opportunity of improving diagnosis and treatment of breast cancer in Afghanistan.

Criteria and Standards for Healthcare Buildings Design through Sustainability Criteria. (Dept. A)

Criteria and Standards for Healthcare Buildings Design through Sustainability Criteria. (Dept. A)

Fire safety management in public health-care buildings: issues and possible solutions

PurposeFrequent fire incidences in various hospitals across the globe with devastating effects on humans and other resources have multiplied. Stakeholders in the health-care sector are worried because of the yearly fire outbreak increase. However, fire safety management has been proved as a successful platform to mitigate fire in health-care facilities. How far regarding public health-care facilities is yet to receive in-depth studies in Malaysia. This paper aims to investigate the issues associated with fire safety management and proffers possible solutions to improve safety in public health-care facilities from the operators’ perception.Design/methodology/approachThe objectives were achieved through a combination of case studies of five selected Malaysia’s public hospitals and a qualitative approach. Thematic analysis with the assistance of MAXQDA (software program designed for computer-assisted qualitative and mixed methods data) 2018, a type of qualitative data analysis software was used to analyse the collated data which emerged from the knowledgeable participants.FindingsLax implementation of safety policy, inadequate water pressure, poor maintenance, inadequate communication system, amongst others, emerged as the issues. Findings proffer five main measures to possibly improve fire safety management in public health-care buildings. This includes a feasible institutional framework, improve the emergency response team, improve the occupational health and safety system and others.Research limitations/implicationsThis paper is limited to exploring the issues associated with fire safety management and proffer possible solutions to improve safety in public health-care facilities from the operators’ perception. Future research is needed to engage useful information in advancing fire safety management in public hospital buildings and possibly developing a qualitative model using a generic fire response model. Also, to investigate the level of compliance with the requirements of a fire safety management plan and possibly develop a well-detailed fire safety plan in Malaysia’s public health-care buildings.Practical implicationsAs part of the paper implications, the paper concludes that improved fire protection systems via modern technologies and training of key staff members in accident response and recovery during fire emergencies should be encouraged. This can be achieved through the enforcement and implementation of a fire safety management plan. Thus, this study is encouraging the implementation and sustainability of a fire safety management plan for health-care buildings across Malaysia.Originality/valueTo the best of this paper’s knowledge, this is possibly the first comprehensive paper on fire safety management in public health-care facilities that engaged operators in Malaysia. Moreover, this paper proffers feasible policy solutions to improve the fire safety management plan in public health-care buildings.

Developing a framework for fire safety management plan: the case of Malaysia's public hospital buildings

PurposeGlobally, several studies have shown that hospital building is charged with multiple inherent risks because a large number of users are vulnerable in tragic events. Thus, the need for the fire safety management plan (FSMP) has been proved as an instrument to mitigate fire and related risks in healthcare facilities. In Malaysia, FSMP regarding public healthcare building is yet to be explored in-depth. Therefore, this paper explores the information necessary to develop the FSMP framework for public hospital buildings.Design/methodology/approachThe paper’s objectives were accomplished via a combination of five face-to-face interviews and observations of five selected public hospitals in Pulau Pinang, Malaysia. The five key participants were across the five public hospitals and collated data analysed through thematic analysis with the assistance of MAXQDA 2018.FindingsFindings show that fire safety stakeholders practice system, fire safety action plan and fire risk management were the three main variables that promote fire safety programme and will improve FSMP for Malaysia’s public hospital buildings.Research limitations/implicationsThis paper’s data collection is limited to Penang, Malaysia, and a qualitative research approach was used, but this does not deteriorate the strength of the findings. Future studies are needed to consider validating findings from this paper via a quantitative approach.Practical implicationsThe suggested framework can be employed by Malaysia’s public hospital authorities as a guideline to mitigate fire hazards in the country’s healthcare facilities.Originality/valueThis paper is encouraging hospital operators and other key stakeholders to improve on their FSMP for healthcare buildings across Malaysia as part of the study implications.

Barriers in Nigeria’s public hospital green buildings implementation initiatives

PurposeThe high consumption of energy by buildings may have enhanced land degradation, flooding, air pollution and many other hazardous environmental issues. However, green practices in buildings have been proved as one of the successful technologies to mitigate these issues. Past studies have shown lax green practices in Nigerian buildings. Concerning public hospital buildings, this is yet to be explored. Therefore, this paper aims to investigate the barriers to green practices and proffer possible policy solutions to promote hospital green buildings.Design/methodology/approachIn attaining these objectives, the view of hospital building contractors, design team, hospital management and policymakers in the relevant ministries/agencies was engaged via virtual interviews. The collated data were analysed and presented in the thematic pattern.FindingsFindings show that green building construction is extremely low in Nigeria, but the worst hit is the health-care buildings across the states. Government/policy-related, organisational/leadership-related, financial-related, technical-related, design team-related and stakeholders’ behaviour-related barriers emerged as the main six themes of barriers affecting public hospital green buildings implementation initiatives. Findings show that proffering possible policies to addressing these barriers may improve public hospital green construction across the states.Research limitations/implicationsThis paper is limited to barriers to green buildings implementation in public hospitals in Nigeria, and data collection was through virtual interviews but does not affect the strength of the findings. Thus, this paper suggests that the sub-themes and variables/items that emerged from the collated data as presented in Figure 1 can be further developed quantitatively via questionnaire survey to validate and improve the reliability of results from this paper.Practical implicationsAs part of this study’s implications, suggestions from this paper will stir up policymakers’ decisions, to be tailored towards achieving green buildings implementation initiatives in Nigerian public hospitals.Originality/valueTo the best of the authors’ knowledge, this paper is probably the first that attempted to investigate the barriers to green buildings implementation in public hospitals in Nigeria.

Combined multi-attribute inpatient thermal comfort requirements in hospitals: A designer's assessment method

Thermal comfort within healthcare buildings has a significant impact on health. If buildings are not adequately designed, variations in hygrothermal can increase morbidity and lead to death. Thus, incorporating various thermal comfort solutions within building design is paramount, and there are various tools that can assist the design of thermal comfort in buildings. However, these tools (and standards) fail to address design trade-offs sufficiently, account for different aspects of the thermal environment within regular patient rooms or consider inpatients’ varied medical conditions and complex underlying factors. To fill these gaps, this research proposes a Hospital Environmental Appraisal Thermal comfort (HEAT) evidence-based design tool. The methods to develop the tool include a systematic literature review, tool design and double validation via a survey questionnaire and interviews with healthcare building designers. HEAT contains eight statements, followed by several evidence-based design recommendations, that address key areas such as design flexibility, coordination, adaptation, activity level, shading, monitoring and airstream. HEAT features three appraisal variants based on a scoring system for statements ranging from general to specific and provides designers with essential information to evaluate and improve design proposals at various design stages. HEAT advances currently available healthcare design tools by providing additional functionality relating to indoor environmental comfort. Thus, this tool would have practical and theoretical implications.

How Can We Adapt Thermal Comfort for Disabled Patients? A Case Study of French Healthcare Buildings in Summer

This paper investigates adaptive thermal comfort during summer in medical residences that are located in the French city of Troyes and managed by the Association of Parents of Disabled Children (APEI). Thermal comfort in these buildings is evaluated using subjective measurements and objective physical parameters. The thermal sensations of respondents were determined by questionnaires, while thermal comfort was estimated using the predicted mean vote (PMV) model. Indoor environmental parameters (relative humidity, mean radiant temperature, air temperature, and air velocity) were measured using a thermal environment sensor during the summer period in July and August 2018. A good correlation was found between operative temperature, mean radiant temperature, and PMV. The neutral temperature was determined by linear regression analysis of the operative temperature and Fanger’s PMV model. The obtained neutral temperature is 23.7 °C. Based on the datasets and questionnaires, the adaptive coefficient α representing patients’ capacity to adapt to heat was found to be 1.261. A strong correlation was also observed between the sequential thermal index n(t) and the adaptive temperature. Finally, a new empirical model of adaptive temperature was developed using the data collected from a longitudinal survey in four residential buildings of APEI in summer, and the obtained adaptive temperature is 25.0 °C with upper and lower limits of 24.7 °C and 25.4 °C.

Automated compliance checking in healthcare building design

Regulatory frameworks associated to building design are usually complex, representing extensive sets of requirements. For healthcare projects in the UK, this includes statutory and guidance documents. Existing research indicates that they contain subjective requirements, which challenge the practical adoption of automated compliance checking, leading to limited outcomes. This paper aims to propose recommendations for the adoption of automated compliance checking in the design of healthcare buildings. Design Science Research was used to gain a detailed understanding of how information from existing regulatory requirements affects automation, through an empirical study in the design of a primary healthcare facility. In this study, a previously proposed taxonomy was implemented and refined, resulting in the identification of different types of subjective requirements. Based on empirical data emerging from the research, a set of recommendations was proposed focusing on the revision of regulatory documents, as well as to aid designers implementing automated compliance in practice.

Hygienic Perspectives of Wood in Healthcare Buildings

Wood materials are being adopted as nature-based architectural themes inside the healthcare buildings. Concern is raised that the organic and porous character of wood might support microbial survival. Therefore, this review discusses the hygienic properties of wood including the antimicrobial potential and its cleanability in comparison to smooth surface materials. In general, wood has antimicrobial properties owing to its chemical composition and physical structure. However, the hygienic potential of wood is influenced by the type of wood, age of wood, the cleaning method, surface treatment, and its moisture content. This information is intended to guide decision-makers regarding the use of wood in hygienically sensitive places and researchers to help them identify the variables for better utilizing the hygienic potential of this material.

Smart contracts for automated control system in Blockchain based smart cities

Nowadays, smart applications are increasing day by day to improve the standard of living in smart cities. A modern-day smart city is characterized by the presence of numerous smart Information and Communication Technology (ICT)-enabled services such as automated healthcare, automatic building monitoring, home automation, smart parking, traffic management, data security, among others. Such cities employ multitudes of Internet of Things (IoT) devices to collect and share data between trusted users by means of a centralized intermediary for monitoring and control of the myriad automatic activities. However, a centralized intermediary is plagued by issues such as single point of failure, risk of data loss, man-in-the-middle attack, and so forth. Blockchain-based smart contracts for automated control in smart cities provide a decentralized and secure alternative. In this paper, an Ethereum based system design for decentralized applications in smart cities has been proposed that enables systems to share data without an intermediary between trusted and non-trusted stakeholders using Ethereum based self-executing contracts. Such contracts allow automated multi-step workflows for smart applications. Two use cases, have been considered namely smart healthcare and smart building monitoring, as proof of stake of the proposed Ethereum based contract. The performance of the proposed scheme for these use cases has been presented with Keccack 256 transaction hash, the total number of transactions, gas consumed by each contract. Such an attempt is a worthwhile addition to state of the art as evident from the results presented herein. The modeling simulation and analysis of hashing power shows that for hashing power greater than 55% the probability of double spending attack reaches to 42% maximum. So it is concluded that the probability of double spending increases with the increase of transaction values.

Life Cycle Assessment (LCA) in the construction of healthcare buildings. Analysis of environmental impact

Currently the optimization of raw materials, energetic efficiency and the reduction of environmental impact are aspects of such importance at the time of choosing a product, process or system. The healthcare buildings are a kind of building composed by a whole group of systems, products and processes. This means a great margin for improvement in energy efficiency and environmental impact caused during the construction as well. The main goal of this project is to verify the viability of applying a case of study of Life Cycle Analysis (LCA) in a healthcare building. After the analysis of the results obtained in previous studies, a series of advantages and drawbacks have appeared as a result of applying this tool in healthcare buildings. The result has been beyond satisfactory, since clear conclusions have been obtained from an exhaustive analysis. Among the most important conclusions, it should be noted that the LCA technique is a great asset to evaluate environmental impacts. The application of LCA methodology helps to reduce the total environmental impact generated during the construction of a healthcare building, having a great impact on social benefit as well as an economic benefit. This last is usually associated to the reduction of waste and operative costs and in the energy savings. Also, it has been proposed some solutions to the main drawbacks. These can be the draw of a guide for the application of the LCA technique or the implementation of educational courses.

THE ROLE OF BUILDING MATERIALS IN THE FORMATION OF THE HEALING PROPERTIES OF MEDICAL BUILDINGS

The article discusses the path of dynamic development, invention and use of common building materials and structural solutions in the architectural design and construction of buildings for medical purposes. The analysis has been carried out since the Middle Ages, continuing and covering the periods of Ukraine-Rus in the XIII-XVII centuries, New time, the newest period in the history of Ukraine. The positive and negative properties of the main natural and artificial building and finishing materials (wood, stone, adobe varieties, building ceramics, glass and other melt types, prefabricated reinforced concrete products, monolithic concrete) are identified and systematized, their role and influence on the development of potential are investigated medicinal properties of buildings, functionally designed to protect the health of the country's population. A number of proposals were provided on further directions for creating modern and progressive architectural solutions for various types of healthcare buildings in Ukraine with the integration and implementation of maximum safety from the use of structures, building and finishing materials, energy-efficient technologies, which together are aimed at the emergence of the latest projects taking into account a sustainable vector, typical for the development of the world architectural and urban planning practice.

Condition-based maintenance of ceramic curved tiles roof in Primary Healthcare buildings using Markov chains

Ceramic curved tile roofs (CCTR) have been used in Spain for ages. This roofing system is very common in Primary Healthcare Centers in Extremadura (Spain). The main objective of this research is to analyze the condition-based maintenance (CBM) of CCTR of Primary Healthcare buildings. Once the condition-based maintenance is analyzed, the optimal maintenance policy and frequency is obtained. A sample of 20 Primary Healthcare Centers in Extremadura (Spain) were evaluated using Markov chains, which represent a useful technique to analyze the influence of frequency and the initial year of maintenance for the increase of the CCTR service life. This study found that the service life of the CCTR can be extended by 8 years using non-periodic condition-based maintenance with a high level of reliability. The end of the service life of this system was also calculated, with a maximum estimated replacement time of about 39 years. Therefore, the maintenance program can be monitored to optimize the operation costs.

Facility management information taxonomy framework for queries in healthcare buildings

Healthcare facilities need to ensure providing safer services to patients without interruptions since disease diagnosis and treatments highly depend on medical equipment and spaces. Therefore, facility management (FM) of healthcare facilities requires a clear and rapid information flow for decision making processes to impede possible interruptions. Non-availability of information, accuracy problems and incomplete information induce more severe problems such as cost overruns, reduced productivity and decrease in customer satisfaction. Thus, this paper aims to develop a strategic information taxonomy framework for FM inquiries in healthcare facilities to address the research problem. Design Science Research methodology cycles such as relevance, rigor and design are adopted during the flow of the research. In the relevance cycle, research requirements and the importance of FMITs were firstly observed with two scenarios, then in the rigor cycle, 64 FM information types (FMITs) were determined, classified and refined under three categories such as; managerial, technical, and financial as a result of literature review and pilot study. Determined FMITs were analyzed with newly developed MonteCarlo Simulation and TOPSIS Techniques on healthcare facilities. As a result of analysis, 62 FMITs were found important for healthcare facilities. The most important FM Informations Types were found as “identification of hazardous or other risks to people or property” (0,985), “real-time operation parameters/post occupancy data integration” (0,939), and “predicted lifetime of assets” (0,818) in managerial, technical and financial information types respectively. Finally, in design cycle, facility management information taxonomy, which was created from determined FMITs, and importance levels of determined FMITs were evaluated with two case studies. Results showed that while maintenance contracts have a positive impact to prevent negative impact of costs, they can cause interruption in information management in facility management. Additionally, there are some view difference in professions. For example, construction management literature focuses wastes that are incurred at the end of building lifecycle or construction process. However, there aren't much attention to manage wastes that occurred during operation and maintenance stage. Beside this, regulations and standards have importance to store, use and manage FMITs. The analysis results acknowledged that the use of information taxonomy framework can increase the effectiveness of the healthcare FM.

Preparedness of Hospitals Post COVID-19 Era

COVID-19 is an unprecedented global crisis, but epidemics have increased in both frequency and reach due to globalisation, greater connectivity, and denser cities. The pace at which healthcare systems were able to respond and the transformation scale are incredible achievements. But they also serve to highlight how ill-equipped the world was for a pandemic of this kind. COVID-19 has shone a spotlight on systems and processes that had been fine-tuned over many decades, revealing flaws and vulnerabilities that we had overlooked, as well as glaring blind spots in our forecasting. During the outbreak of the current COVID-19 pandemic, there were several problems faced by healthcare providers worldwide. A few of these were the shortage of spaces to handle the patient surge, availability of advanced equipment, overburdened doctors and paramedical staff, quality of services, and awareness about disease prevention. It is believed that the world may have to live with such viruses indefinitely. There is a need for shifting, changing, and altering the design and construction of hospitals to tackle such pandemics. Future hospitals should have more flexibility and adaptability to handle pandemics and other outlier events that enable rapid preparedness of staff, facilities, and processes to manage an unprecedented influx of patients. In this article, we are trying to answer some of the biggest questions faced by experts: "what shall be the design of future healthcare institutions which are capable enough to handle such pandemics? What lessons can be learnt for the future design of hospitals, as well as other healthcare buildings? Do we need to adapt and refurbish preparing for a second, third or fourth wave of infections? What will the long-term impact be on building typologies and layouts, strategic planning and investment?" We discuss the following major issues and suggest themes that could affect the design of such institutions and clinical services delivered by them.

A life cycle analysis of ionizing radiation shielding construction systems in healthcare buildings

Optimization of material resources, energy efficiency and reduction of environmental impact are basic aspects in selection of a construction system. The aim of this study is to evaluate the environmental impact generated by different shielding systems for walls of an X-ray room in healthcare buildings. Eight commercial construction systems for anti-X shielding were analysed. A Life Cycle Assessment (LCA) was performed by SimaPro using the Ecoinvent database, and a single-score damage category analysis was performed for midpoint and endpoint levels. Prices of installation and working time employed in the construction of a functional unit of each system were obtained. Solutions with clay brick, cast-in-place reinforced concrete and sprayed concrete were the most favourable for the different categories. Sprayed concrete obtained 6.739 points/m2 of against 165.12 points/m2 of rolled steel option. The damage to human health occupies between 41% and 87% of the total impact in the protection areas. The impact category of human toxicity is also the broadest in the midpoint approach. Considering time and cost of implementation, clay brick solutions proved to be the most favourable, along with cast-in-place reinforced concrete and barite concrete. System #6 is the most environmentally friendly, 1.6 times less than the next one (which is #4), although its unit price is 1.94 times the cheapest (which is #2) and its execution time is 1.89 times the lowest (which is #2 again). The knowledge generated in this study will improve investment decision making for the planning departments of the Sanitary Systems, obtaining an economic, social and environmental benefit. The main novelty of the work lies in the object of the study (X-ray room) as well as in the integration of LCA and economic aspects.

A new vision for primary healthcare

Gianpiero Celino, Clinical Director, Cegedim Healthcare Solutions, outlines a plan for healthcare building on the progress made by the NHS during 2020

Analysis on aroma components of flowers of five Magnolia denudata cultivars

Aroma components in fresh flowers fromfive Magnolia denudata Desr are analyzed with Head Space Solid PhaseMicro-extraction (HS-SPME) and Gas Chromatograph-Mass Spectrometer (GC-MS) technology. The results show that 45 compounds are detected in the flowers offive germplasm of genus Magnolia denudata Desr, including 19 alkenes, 5 alcohols, 5 benzenes, 4 ketones, 3 esters, 2 ethers, 1 acid, 5 alkanes and 1 other compound. The type number of volatile organic compounds (VOCs)from more to less in order are: Yulania denudata ‘5#’ (22 species), Yulania denudata ‘Fei Huang’ (21 species), Yulania stellata (15 species), Magnolia liliflora Desr(12 species), Magnolia liliiflora ‘Hong Yuanbao’ (10 species);The content of volatile organic compounds from high to low areYulania stellata (28%), Yulania denudata ‘Fei Huang’ (26%), Magnolia liliflora Desr (17%), Magnolia liliiflora ‘Hong Yuanbao’ (15%) and Yulania denudata ‘5#’(14%). The type and content differences of volatile organic compounds (VOCs) in the flowers offive germplasm of genus Magnolia denudata Desr are comparatively big. There has been no research reports about the contents of volatile organic compounds in the flowers of Yulania stellata, Magnolia liliiflora ‘Hong Yuanbao’ and Yulania denudata ‘5#’. In conclusion, this study is expected to better clarify the component and content of VOCs from the flowers of different Magnolia denudata Desrcultivars, and provide the scientific basis for the health-care type garden green space building.

Wayfinding in hospital landscape: syntactical analysis of planting design in hospitals in Kerman, Iran

PurposeHospital landscape is not a useless space within hospital buildings anymore. It is considered as a supportive area providing mental and physical peace. However, the planting design of the hospital landscape and the way it should be in order to not disrupt wayfinding performance is neglected. This paper, which is a case study, aims at investigating the effects of planting design in Kerman hospitals’ landscapes on the users’ wayfinding using space syntax techniques.Design/methodology/approachThis research focuses on the effects of planting design on the users’ wayfinding in hospitals. In so doing, library research, computer simulation and analysis with the University College London (UCL) Depthmap software, and comparison techniques are used. Based on axial maps, the measures of integration, connectivity and intelligibility are considered for analysing the wayfinding process of individuals.FindingsThe findings show that planting configurations in the hospital landscape can affect individuals’ wayfinding. Integrated and regular planting design in addition to combining planted areas with the hospital buildings can pave the way for intelligible space and easier wayfinding.Originality/valueAccording to the authors’ knowledge, the current study is the first to use the space syntax techniques in the health-care landscape architecture in terms of planting design and wayfinding. As wayfinding is an important issue in health-care spaces, the study findings can greatly help the health-care building designers and the related organizations to pay attention to the hospital landscape as much as hospital indoors.

Study of the energy intensity by built areas in a medium-sized Spanish hospital

Assessing energy use in healthcare buildings requires identifying consumption profiles regularly. Keeping this in mind, this paper studies the energy intensity of a hospital and sets specific energy performance indicators by healthcare area. The authors analysed a hospital located in the province of Madrid (Spain), equipped with 182 beds and an area of usage of 25,177 m2. The heating, ventilation and air-conditioning system (HVAC) and steam production equipment (63.0%) and medical equipment (18.8%)—which includes electromedicine (11.6%), radiology (4.2%), radiotherapy (0.7%) and nuclear medicine (2.4%)—accounted for 81.8% of the energy consumed. Throughout the analysis, the authors found that operating theatres and intensive care units demanded more than 1000 kWh/m2 per year, while catering and nuclear medicine required between 500 and 1000 kWh/m2 per year and radiology between 350 and 500 kWh/m2, and most of the other units did not exceed 250 kWh/m2. The wide variability of these results shows that each area’s energy consumption should be studied separately for an appropriate energy management. These indicators are useful for benchmarking between hospitals, thus prioritising energetically efficient investments.