PROJEK PEMBANGUNAN HOSPITAL KUALA KRAI (2014-2017)
PLANNING & DESIGN CONCEPT AND PRINCIPALS:
The existing Hospital Kuala Krai (HKK) was built in 1917 on 10.269 hectares of land. HKK also acts as a second specialist centre for Hospital Gua Musang, Hospital Machang and part of Tanah Merah area and is the second referral centre for State of Kelantan. HKK has been identified as one of the major specialist centre for Kelantan State after Hospital Raja Perempuan Zainab II (the State Hospital) and covers a total population of 276,000 from Kuala Krai, Machang and Gua Musang.
The existing Hospital Kuala Krai was originally planned to accomodate 120 beds and currently has 150 beds. It has had an average bed occupancy rate (BOR) of 66% – 70% from 2006 to 2010. Based on the norm of 2 beds per 1,000 population, with 276,000 populations in 2010, the district needs a hopital with approximately 552 beds. However, Machang and Gua Musang already have their own district hospital providing a total of 176 beds. Therefore, Kuala Krai District is still short 376 beds to cater for the total population from the three districts.
The Ministry of Health (MOH) has identified the need to have a new hospital with comprehensive specialist services in the district of Kuala Krai. The new site has already been purchased by MOH and is located 5km away from the existing hospital. This replacement for the existing hospital will consit initially of 268 beds with the ability for future expansion to 350 beds.
LOCATION OF SITE
The new hospital will be built on a 40 acres land within 100 acre land that has been purchased by MOH. This land is located on Lot No. 1623/B in Mukim Kual Pahi, Daerah Batu Mengkebang, Kuala Krai Kelantan. This land is located about 5km from the old hospital and town. The earthworks to achieve the platform level have been completed under Phase 1 of this poject.
HOSPITAL IN THE PARK
From the outset, our concept has been to accommodate the intricate planning requirements of a Hospital in a compact complex of buildings, which maximize the potential of the site whilst utilizingthe existing platform levels and natural features. Adopting this design strategy will result not only in a more economical building to construct and a more efficient building to operate, but more importantly, a building which is user friendly and easy for the public to navigate.
Hospitals, by their very nature, can be intimidating places for the public to visit. For this reason we have developed a concept where Landscaped Courtyards aid public orientation and act as points of reference. This is a radical departure from the normal practice of relying solely on building elements and directional signage to guide the public through a maze of hospital corridors.
We call this concept a ‘Hospital in the Park’ and believe that it will become the enduring legacy of Hospital Kuala Krai.
The proposed hospital is located to the East of the existing stream and is laid out on a main axis from the Kuala Krai Highway.
Pedestrian access is along this axis from the bus stops, taxi ranks and carparks that are located adjacent to the Kuala Krai Highway. Pedestrians approach the hospital along a Tree Lined Boulevard, over a feature bridge and through a Landscaped Courtyard. The Main Pedestrian access is at Level 2, which is the same level as the Main Entrance Lobby.
The building is orientated on a Notrh-South axis to minimise the building exposure to the building surface area to the sun in order to reduce the solar heat gain in the building
BUILDING EXPANSION PLAN
The diagram above shows the possibility of expansion areas like the car-park to be replaced with future de
velopment for the hospital block.
There is still abundant spaces to provide ground level parking.
There future expansion to locate staff residential facilities is a natural progression to the west of the site
SCOPE OF SERVICES
PROVISION OF CARE
The hospital will emphasize on achieving excellent services to meet the demand for increasingly complex healthcare requirements in these selected fields. Ultimately, the hospital will focus on fulfilling the objectives as listed below:
• To provide advanced and appropriate clinical expertise available in the relevant specialties.
• To provide advanced and appropriate standard of technology in medical care, medical equipment, information system, infrastructure and others.
• To optimize hospital operations and resource utilization by an information technology-driven operational environment.
• To create a conducive and caring environment for patients and staff.
• To enhance collaboration and active participation with health and health-related agencies in providing quality services.
• Daycare (medical/surgical/endoscopy/)
• Specialists Clinics
IN-PATIENT SERVICES (268beds)
There are11 wards to cover medical, surgical, orthopedics, obstetrics& gynecology and pediatrics. Critical care is provided in the Intensive Care Unit (ICU), Pediatric Intensive Care Unit (CCU), Neo-Natal Intensive Care Unit (NICU) and Special Care Nursery (SCN).
A step down critical care; Coronary Care Unit (CCU/CRW) and High Dependency ward is also provided.
DIAGNOSTIC AND TREATMENT SERVICES
Operation Theatre Complex consist of 8 nos. of Operating Rooms including one each for Emergency Labor Delivery Suite will operate with 8 LDR with future extension of 4 LDR. There will be provision of 4 bed cubicles for high risk cases. The Pregnancy Assessment Centre (PAC) operates 24 hrs throughout the year for emergencies dedicated for pregnant mothers.
• Imaging (General X-ray, Fluoroscopy and CT Scan)
MEDICAL SUPPORT SERVICES
• Central Sterile Supply for distribution of
sterile to all departments.
• Central Medical Store for storage of meterial
supplies for the hospital.
NON-MEDICAL SUPPORT SERVICES
• Administration of the hospital management,
academic staff, nursing and other support staff
• Linen, Housekeeping and Cleaning, Porter services,
Transport and Ambulance logistic, Security,
Waste Management, Engineering Services
management and maintenance.
• Catering/ Dietetics
TRAINING AND EDUCATION SERVICES
• For continuous medical education for staff
• Staff quarters (Nurses Hostel and
• Outdoor Recreation
MEDICAL SPACE PLANNING STRATEGY
This hospital is conceptualized on the following attributes
(a) Efficiency and Cost Effectiveness:
The planning and design takes into consideration efficiency factors :
(i) Minimum inter- distance between frequently traveled functional spaces.
(ii) Greater visibility angles for effective supervision by a minimum number of staff.
(iii) Careful planning to include all needed spaces and excludes unnecessary ones.
i(v) Effective logistics i.e. Lifts, ramps, handling of food, clean supplies, and waste removal etc.
(v) Direct access to out- patient areas.
(vi) Grouping of functional areas having similar system requirements.
(vii) Departmental zoning for the appropriate placement of co-related functions.
(b) Flexibility and Expandability:
Modes of treatment and medical needs will keep changing, therefore considerations
were given to the following::
(i) Modular spaces in planning.
(ii) Modular electrical and mechanical system for easy access and modification.
(iii) Vertical expansion probability.
(iv) Open end approach to planning i.e. soft space such as parking and landscape areas for expansion.
(c) Therapeutic Environment:
(i) Stress free and comfortable environment.
(ii) Use of familiar and culturally relevant materials in interior design.
(iii) Variations in colour and textures for finishes.
(iv) Ample natural lighting.
(v) View of outside from patient bedrooms, treatment areas and elsewhere.
(vi) Artwork and signage for easy way finding.
(d) Hygienic and Clean:
(i) Durable finishes.
(ii) Crevices and joints which are hard to clean are avoided.
(iii) Adequate and well located housekeeping spaces.
(iv) Operation and manning aspects i.e. economics of scale, energy, conservation, resource management, safety and comfort.
(e) Controlled Circulation:
(i) Outpatient visitors restricted to diagnostic and treatment areas.
(ii) Defined outpatient routes.
(iii) Direct access route of visitors to nursing stations.
(iv) Separated areas of visitors / patients from logistic areas.
(v) Separated movement of waste, food and clean supplies from patients and visitors.
(vi) Dedicated lifts for services, patients and staff
(i) Maximum use of natural light, textures and materials.
(iii)Colour, proportions and details.
(v) Bright common open spaces.
(vi) Homelike and intimate scale.
(g) Security and Safety:
(i) Security for hospital property and assets.
(ii) Security for patients and staff.
(iii) Control of violent and unstable patients.
Hospitals are heavy users of energy and also produce large amounts of waste. Therefore the environment around the proposed building takes into consideration sustainable and low maintenance material for walls, floors and ceiling. Water for general cleaning and watering of plants is channeled from the rain-water harvesting chamber.
Our planning concepts and ideas respond to the healthcare organizatation, medical and pharmaceutical advances, medical technology developments and patient expectations. Some of these concepts are :
• Healing healthcare environments
• Patient focused design
The design utilizes the existing platform levels to organize areas with different functions into separate zones in the following manner: The main Entrance is the single point of entry for Out-patient, In-patient, public and staff.
Upon entrering the Main Entrance Plaza, Admission & Revenue is located upfront to allow direct access. Cafeteria is centrally located to accomodate public and Outpatient also to compliment the view towards Central Courtyard.
The Emergency Departmnet is located on the lowest platform level immediately to the East of the existing stream with dedicated drop-off area sharing with PAC. This maximizes its visibility from the Kuala Krai Highway and helps to allow for direct access. Clear signage will point the direction for those needing emergency services. The Imaging Department which provide 24hours services is next to the Emergency Department and also accessible to Out-patients and In-patients by conviniently placed lifts lobbies.
The Rehabilitation Department is appropriately located to allow easy access at ground level for Out-patinet and accessible by lifts for the In-patient.
The Dialysis Department is provided by a ”Drop-off“ point for those from outside the hospital and In-patients are brought to the department by hospital porters.
Also located on this level is the Mortuary with its own service court to allow privacy for grieving relatives as well as shielding the loading and unloading of the dead.
The Medical Store and Catering Department is connected to the service road with load / unload bays. The Inpatient Pharmacy and CSSD is located next to Medical Store for make ease the supplies
The privatised services such as Linen, Housekeeping Unit,Engineering Services and Porterage & Transportation is located on this level sharing the loading and unloading area
In keeping with our concept to create a compact complex of building, the Out-patient Departments and In-patient Departments are housed in the same block but on different levels.
The Out-patient Department are located within the Western Wings of the hospital at level 2 via escalator directed from Main hospital Lobby to Level 2. Upon reaching the Outpatient floor, Main Registration and Outpatient Pharmacy and Clinical Lab area strategically located to make ease the flow of patient. Adjecent to that, General Surgical/ Orthopedic/ Anaesthesia Clinic, General Medicine/ Dermatology / Psychiatric Clinic, Paediatric clinic, O&G Clinic, ENT & Opthalmology Clinic and Dental Clinic are located near-by
Daycare Unit with Endoscopy Unit also located at this floor. Pathology and Medical Record are located at this floor to make provide faster handling the samples and records for Outpatient.
This is the semi-private areas of the hospital where there will be a significant reduction of public access except for relatives of patients in critical care.
The Labor Delivery Suite also caters for emergency obstetric cases and will operate 24 hours. NICU /Special Care Nursery are located adjecent to Labour Delivery as they share the service lift for transport the Inpatient to ward and vice-versa.
The Operation Theatre Complex consists of 8 nos. of operating rooms with adjacent connection to the ICU / PICU ward to allow direct tranfer of post-op patient.RHU is located in between ICU and OT to make ease the transportaton of ventilator.CRW/CCU are located adjacent to Health Promotion Resource Center
Reaching to the top most podium level on Level 4, Specialist Office Complex and Auditorium are located on one side of the building where as the other side occupied by ICT, Library and Administration Unit connected by the bridge.
Level 5 & 6
At Level 5, the Inpatient ward are begin with Paediatric Ward, ENT/EYE & Dental Ward, Obstetric & Gynaecology Ward 1&2. Going up to Level 6, there are Orthopaedic Ward and Medical Ward. Both ward are provided for male and female patients.
The configuration of functional spaces in a hospital is primarily dependent on the following:
(a) Vertical connecting spaces i.e lifts, ramps and staircases.
(b) Horizontal connecting spaces i.e Link Bridge, passages and corridors.
(c) Constraints and opportunities of the site.
(d) Surrounding facilities which are already existing or being planned.
(e) Current and new availability of Hospital Technology.
The diagrams show the hospital functional and inter- relationship of various functional spaces of the hospital. The traffic flow from one functional space to the other and their functional inter relationship dictates the placement of these spaces with respect to each other
PROPOSED DEPARTMENTS IN THE HOSPITAL
Specialist Clinics in the hospital operate during office hours from Mondays to Fridays. Patients may be referred to the clinics from the Primary Health Centre and other MOH facilities or from private practitioners and also cases from the Emergency Department. The disciplines covered come from medical, surgical, orthopedics, O&G, Pediatrics, and Rehabilitation.
All the consultation/examination rooms for each discipline will follow the same template for sharing of clinic support services. There will be shared spaces and centrally located support, treatment and diagnostic spaces.
The Daycare services cover day surgical procedures, endoscopy and day medical treatment. There will be 10 beds and 10 recliner chairs. Endoscopic procedures are done here whilst surgical procedures are carried out in the O.T situated in the main O.T. Suite on the same floor.
Dialysis for in- patients will be done at the bedside or taken to the department located on the ground floor just next to the main entrance.
Still in the Out-Patient’s zone is the Rehabilitation Department which consists of a fully equipped gymnasium for adults and pediatric therapy.
The In-Patient zone or the Wards is dominated by the patient accommodation on two floors and half a floor at level 4 for the critical care patients .The beds distribution is described in a later section. The wards layout is accommodated in a repeated template and each patient bed space will have the maximum possible view from the nurse station which is central to all spaces.
Each ward unit has an acute bay for higher dependency care patients and each ward unit will have a minimum of two isolation rooms with air/lock entry to separate patients suspected with infectious ailment and to manage security patients.
The colours and textures of materials play a major role to create a comfortable and pleasant ambience especially for the Pediatric ward.
The Diagnostic and Treatment zone is synonymous with the main Operation Theatre Suite which consists of 8nos. O.T. rooms. This department is located on a semi private floor with restricted visitor access.
The Intensive Care Unit (ICU&PICU) with 14 beds and the combined Coronary Care Unit with High Dependency Ward which has 18 beds is located adjacent to the O.T for easy and private transfer of patients. There is a comfortable waiting area for relatives and visitors.
The Delivery Suite has 8 delivery rooms with future accommodation for 4 delivery rooms. Emergency cases for pregnant mothers will be attended at the Patients Assessment Centre which operates 24 hours.
The Neo-Natal intensive Care is combined with the special Care Nursery Unit with 18 incubators located next to this department. This is a secure zone for safety and security of the newborns.
The Imaging Department is located close to the Emergency Department and accessible to the specialist clinics at two floors above.
The management of the hospital is carried out in the Administration Department located on level 3. There is provision of a common open plan office, individual offices, a group sharing an office. There is also a Nursing Unit, an Academic Unit and the Information Technology Unit. On the same floor is also the Medical Records Unit. There is a connecting bridge in this level to the CME Building which also houses the specialist office and the Health Education Unit.
There are meeting rooms and a board meeting room in the department and. Doctors and staff lounges is made pleasant and cheerful for rest and relaxation between tasks.
At of the hospital is the “heart” of the hospital, the intricate combination of the mechanical and electrical services to keep the hospital running in good and efficient condition
There is a well equipped Pathology Laboratory located on level 3. Except for the blood bank/blood donation centre, all specimens for lab investigations is done at point of request in the clinical labs. Stationed at the Out-patients (Specialist Clinics)
Out-Patients obtain their medication/prescriptions at the Out-Patient’s Pharmacy and the in-patients get their medication at the bedside taken by schedule in medication carts from the satellite pharmacies on every floor.
Sterile items for the clinical departments come from the Central Sterile Supply Department (CSSD), clean linen is delivered to the hospital and Dirty Linen collected for washing.
Facilities for the public are provided at the main lobbies and the zones of heavy people traffic. Cafeterias and retail shops offer patients, visitors and staff food and beverages and options to purchase gifts, flowers and other items to cheer the patients.
Registration counters in the hospital are people and disabled friendly. There is provision of, prayer rooms and quiet meditation areas
Training and Education facilities are provided in a separate building with a 200 auditorium seating capacity. There are seminar and meeting rooms for the staff and students. The library provides reference materials for the on-going and continuous education
Vehicular access is provided on either side of the pedestrian access. Separate dedicated vehicular access for emergency is located on one side, with public vehicular access to the Main Hospital on the other side. Service and staff vehicles share the emergency road, thus ensuring that there is separation of service, emergency, staff and the public.
Horizontal and Vertical Movement
Circulation is designed to integrate departments of the hospital so that different types of traffic (service, deliveries & disposals staff, patients & public) traversing the length and breadth of the hospital is able to follow a simple route through the corridors along the hospital street and move vertically to each floor by way of staircases and lifts. Way finding is assisted by the well placed directional signage.
Protection, Safety and Security of Patients
Minimizing services intrusion into patient’s space ensures smooth and efficient care and well being. Patients need to be protected against harm and from the risk of hospital acquired infection diseases. There will be monitored access along the corridors and accessibility to the lifts and staircases
Shortest Traffic Routes
Unnecessary steps cost money, time and fatigue and increase the chances of infection. Therefore the corridors are straight forward and direct to minimize walking distances.
Separation of Dissimilar Activities
This will minimize the chances of infection, help towards better organization, a more efficient working arrangement, saving time and steps, and reducing confusion.
Quiet and noisy activities are likewise separated
Control is Vitally Important
Nurses exercise control and supervision over patient corridors in the clinical areas The security at the main entrance controls the coming in and going out of visitors.