Healthcare Architecture:  The Design of Cardiac Facilities

The central horseshoe shape in the gamma camera scan at the left is the muscle of the left ventricle of the heart. The left ventricle is the largest chamber of the heart, with the thickest muscular wall. When it contracts, it pumps blood to the rest of the body – the right ventricle pumps only to the lungs, which are nearby. When investigating after a heart attack, this is the muscle that is scanned, since it is possible to tell from its condition how much tissue has died. The heart seen here can be seen to be a healthy one, since the horseshoe shape is continuous; after a heart attack, the shape would be broken up.

In fact, more importantly than the shape of the left ventricle, after a heart attack many people’s lives as well as those of their families are broken up. Such people require firstly the attention of a cardiologist, a person who specializes in diagnosing and treating diseases of the heart. They may even require corrective surgery, which is performed by a cardiac surgeon. The “doctor’s workshop” in which all this diagnostic and therapeutic investigations and treatment takes place is known as a cardiac care center, the architectural design of which is the focus of this article.

The Operation Theater Suite is truly the “heart” of a cardiac hospital, for this is where the bypass surgeries are performed (doctors call them CABGs,  for Coronary Arterial Bypass Grafts), and these theaters are designed adjacent to cardiac catheterization laboratories. In these “Cath Labs”, as they  are more popularly known, angiographies and angioplasties are performed by cardiologists. In a rare instance, an angioplasty procedure will puncture  the wall of the artery, and emergency surgery will be required, hence the contiguity. The theaters should be provided with HEPA (High Energy  Particulate Arrestors) filters and dedicated air-conditioning conforming to applicable standards of sterility. The Cath Labs do not require the same  degree of sterility as the Surgical Suite, as the procedures are minimally invasive (there is no gaping wound). The Cath Labs should be contiguous to  a day care ward, as “graphies” are a day care procedure. Many times however, the apprehensions of patients and relatives make them opt for an  overnight stay in the hospital.

The theaters are usually also contiguous to the Surgical ICCU (Intensive Cardiac Care Unit), on the same floor if the particular design circumstances allow it. Each pair of cubicles In the ICCU should have an observation station with a sink, to enable continuous, comfortable attention to each patient by nursing staff, and also be conducive to preventing cross-infection by enabling nursing staff to wash their hands after each patient interaction.

Structural design for the building should be done to facilitate future changes in layout and to provide for new demands that these changes may make on building services like electricity, air-conditioning or plumbing. The podium slabs should be designed to support new walls at any point. A grid slab allows for punctures anywhere. Service shafts, column design, elevator provisions and water supply and sewage pipe sizing should allow for substantial, planned expansion.

Successful hospitals grow, and more often than not this growth can be a painful and traumatic process for the hospital. It needs to be planned for in advance, ideally at the time of planning the initial facility itself.

Changing market demands, new technology replacing the old at an ever-increasing rate of change, advances in the science of medicine and changing patterns of disease all underline the need to design healthcare buildings for flexibility. The functional, technical and hence financial success of hospitals thus depends on the ease with which they can grow and change, and this dependence increases with time.

The fact that many hospitals are built in a number of phases further complicates the problem. There may be limits to the amount of investment possible at any one time. A comprehensive and firmly established Development Control Plan is essential for a hospital built in phases – to specify the strategic direction of following phases.

The issue is complex; it involves a multiplicity of design factors that may be making contradictory demands on the designer. If you are building a hospital, we suggest you consider the various options keeping in mind the needs of future generations to whom you will bequeath your design solution in its built form.

The interior spaces of the hospital should be drenched in natural light and the facility should be wrapped it in abundant greenery, thus enabling the building structure and its interior spaces to become an active partner in the process of healing. Light also affects the human body. Patients can become psychotic through sensory deprivation or sensory overload. It is tremendously important to experience the natural cycle of light and dark and to be wheeled out into the sun. A terrace garden should be provided for this very purpose, and most importantly, the Intensive Care units should have ample natural light designed into them.

Instead of allowing technology to make medical care seem more sterile and impersonal, the hospital should use technology in an invisible way to speed the delivery of care and make patients even larger partners in their healing.

This enabling of patients to affect their treatment in a meaningful way by being informed of all that will happen during their stay and made to discuss this proposed series of activities with the care-givers is an important operational policy in hospitals tuned into the new paradigm.

The interior design of the hospital should be done with the intention of reducing stress by creating a more relaxed environment and supporting the patient’s dignity and identity. It is necessary to have a patient-focused, collaborative design effort between the architects and the interior designers, to create an environment conducive to healing. This holistic approach to design makes good sense in terms of patient, staff and visitor satisfaction and it’s effect on patient recovery, which is of considerable interest to health care providers.

Hospitals, cardiac or otherwise, as vehicles for improving the health of the community they serve, should take the lead in embracing “green” or “sustainable” architectural design processes, they should be designed to minimize their energy demands and use eco-friendly design and construction processes.

What does the future hold for cardiac surgery? In an era of new technologies and increased health awareness among people in general, the following factors will have an impact on this:

1.  New, drug-coated stents will make angioplasty an increasingly popular and effective alternative to surgery.
2. Improved imaging techniques within the Operating Theater will allow minimally invasive cardiac surgery.
3. “Beating heart” surgery has already reduced the need for heart-lung machine usage.
4. Improved drug regimens will dissolve clots without the need for any invasive procedure.
5. Early diagnosis by scanning high-risk patients will lead to increased heart healthiness through timely changes in lifestyle. The emphasis is changing from cure to prevention.

What do these changes foretell for the architect and the design of cardiac facilities?

1. Increased emphasis on and usage of outpatient consultation, diagnosis and procedures and hence the greater need for such facilities.
2. Increased need for the cardiac facility to take the lead in preventive measures by community outreach programs, and hence the physical need within the facility for holding workshops, lectures and exercise programs. This leads to the aesthetic of the building suggesting a more welcoming and less threatening outward face.
3. Inpatient care becoming more acute, with the average inpatient being a “sicker” patient. This could lead to the conception of the inpatient room as a “mini-ICU”, in terms of facilities, space and layout.

What factors would contribute to the success of a cardiac care facility? Three important factors:

1. Competent consultants from the onset of the project.
2. The vision of the client.
3. The vision of the client.

This cannot be emphasized enough. Maybe I should have said it three times. Everybody concerned with the project takes their cue from the leader, and if he/she does not have clarity of vision, all the concerned minds will be as cloudy.

The client must demand quality. In my firm, we believe that quality is a state of mind, not an optional extra. It cannot be bolted on. The lead must come from a strong and committed client, and the pursuit of quality then forms every strand of the process.