Hospital Thesis Chapter 3a

(1)

REFERENCES

3.1 REVIEW OF RELATED LITERATURE 3.1.1 Non- Architectural

3.1.1.1 A Checklist to Facilitate Cultural Awareness and Sensitivity

From J Med Ethics 2002; 28: pp 143-146 3.1.1.1.1 The Article and its Relevant Information

EXCERPTS

A highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients.

“Culture is an organized group of learned responses, a system of ready-made solutions to the problems people face that is learned through interactions with others in society.” Thus, it is essential to consider culture's role when designing the best possible recovery program. We agree that “culture shapes responses to illness and treatment”. These responses guide the level and progress of recovery. Knowledge of the patient's culture and sensitivity to its basic premises is imperative for quality treatment and recovery.

Cultural sensitivity for those working in health care can be viewed as being “sensitive to the ways in which community members' values and perceptions about health care differ from his or her own”. With the world population continually growing and the percentage of minorities steadily increasing, the importance of cultural sensitivity is in critical need of attention. Future doctors and nurses are currently being trained in the subject of diversity.

“Without understanding the cultural context on which the client builds his/her understandings of

(2)

MINA DE ORO PROVINCIAL HOSPITAL AND CENTER FOR RESPIRATORY HEALTH Application of Therapeutic and Healing Design Approaches in a Patient- Centered Health Facility

information, the managed care process will not succeed.”

Another term, culturally competent health care, requires that the health professional be sensitive to the differences between groups, to the differences in outward behavior, and also to the attitudes and meanings attached to emotional events such as depression, pain, and disability. This model is used to improve the quality of care by recognizing culture's influence.

Instead, we are encouraging health care providers to look more deeply at, and be more sensitive to, the range of factors that play a role in the recovery process.

Achieving cultural education is a team effort. Members of particular cultures and ethnic groups must be willing to share information while practicing a great deal of patience. The patient and associated family members need to be encouraged to help educate their caregivers and vice versa. As an added bonus, the role of educator will assist in actively involving the patient and family in the recovery process while helping ameliorate the fear of the unknown, which can play an adverse role in recovery. Education may also help stabilize the patient's support group to better assist in the recovery process.

THE CULTURAL SENSITIVITY AND AWARENESS CHECKLIST

1. Communication method: Identify the patient's

preferred method of communication. Make necessary arrangements if translators are needed.

2. Language barriers: Identify potential language

barriers (verbal and nonverbal). List possible compensations.

3. Cultural identification: Identify the patient's

culture.

4. Comprehension: Double-check: Does the

patient and/or family comprehend the situation at hand?

5. Beliefs: Identify religious/spiritual beliefs. Make

appropriate support contacts.

6. Trust: Double-check: Does the patient and/or

family appear to trust the caregivers? Remember to watch for both verbal and non-verbal cues.

7. Recovery: Double-check: Does the patient

(3)

considerations.

9. Assessments: Conduct assessments with

cultural sensitivity in mind. Watch for inaccuracies.

10. Health care provider bias: We have biases

and prejudices.

3.1.1.1.2 Application to Study

Important Statements are written in this study which will give or show significance of a culturally sensitive health service. In every facility, users are the most important feature of design considerations. Users of a health facility is diverse especially in Mindoro where poo Mangyans are being discriminated in every sector such as education, health and territory. As said in this paper, “Without understanding the cultural context on which the client builds his/her understandings of information, the managed care process will not succeed.” Culture will shape the spaces so that the responses of the client or user will be acceptable and humane

3.1.1.2 RETA 6143: Technical Assistance for Promoting Gender Equality and Women Empowerment

Culture Sensitive Maternal and Newborn Care Program:

Experience with the Mangyans of Oriental Mindoro by Family Medicine Research Group, Inc.

3.1.1.2.1 The Article and its Relevant Information ABSTRACT

Background: Access to health facilities and skilled health workers towards is not easy for indigenous people in far flung areas but if key personnel in the nearest communities can be equipped with adequate knowledge, encouraging attitudes and focused skills in care during and after pregnancy as well as childbirth, then perhaps the needs of mother and their newborn and the factors that can affect their utilization of services can be adequately dealt with.

(4)

provision of Maternal and their Newborn care services to Mangyans in three pilot areas of Oriental Mindoro

Methodology: The overall design of the study was a mixed qualitative and quantitative process involving data collection methods such as focused interviews and key person interviews using semi-structured questionnaires. Key person interviews were conducted in rural health units with the interview questions developed based on study objectives. All interviews were documented thru digital audiotapes and subsequently transcribed verbatim by three independent research assistants. Semi-structured questionnaires which include vignettes, attitude scales and practice questions designed to elicit opinions, perceptions of health workers towards Mangyans who are accessing the services provided by the rural health units

Result: Health workers perceive Mangyans as peace-loving, hospitable, humble and good-natured people. However, they are also generally described by the health workers as shy, untidy and uneducated. They are often thought of as apoor hence they lack knowledge and the financial resources to utilize health care services. The most common descriptions why health workers dislike Mangyans who come in at the health care services. The most common descriptions why health workers dislike Mangyans who come in at the health center were their uncleanliness and their body odor. Generally, they are comfortable among the younger generations of health workers, the usual reasons cited

It shows the feasibility of providing spaces for Mangyan as they are already accepting professional healthcare and also, the LGUs (Local Government Units) are already making necessary actions to provide a culturally sensitive health programs. The provision for a culturally sensitive health facility will compliment this related literature.

3.1.2 Architecturally Related Literature

3.1.2.1 Therapeutic Environments

From the Therapeutic Environments Forum, AIA Academy of Architecture for Healths

3.1.2.1.1 The Article and its Relevant Information EXCERPT

Healthcare facilities are designed not only to support and facilitate state-of-the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient,

(5)

outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction, and organizational outcomes. The effects can be positive or negative. No environment is neutral. A healthcare environment is therapeutic when it does all of the following:

 Supports clinical excellence in the treatment of the physical body

 Supports the psycho-social and spiritual needs of the patient, family, and staff

 Produces measurable positive effects on patients' clinical outcomes and staff effectiveness

A. Theory / Background

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 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

Research on completed projects by organizations including the Center for Health Design, Texas A&M University's Center for Health Systems Design, the Academy of Neuroscience for Architecture, and by a growing number of architectural firms and their clients shows measurable benefits to patient outcomes, safety, and quality of care, from such factors.

(6)

The application of these factors has been focused on the patient and patient's family. However, there are also recognized potential benefits for staff and caregivers in terms of satisfaction, effectiveness, and staff retention, from environmental factors such as:

 Noise reduction

 Same-handed patient rooms

 Access to daylight

 Appropriate lighting

 Providing 'off-stage' areas for respite

 Proximity to other staff

 Appropriate use of technology

 Decentralized observation, supplies, and charting

The benefits staff receive from these environmental factors may impact the quality of care patient’s experience.

In general, Therapeutic Environments have been proven to be cost-effective by improving patient outcomes, reducing length of stay, and by enhancing staff satisfaction, recruitment, and retention of staff.

A patient centered Hospital Facility is the main approached of the study through application of Therapeutic Architecture and Healing Environments. The article will serve as guidelines on how I will achieve and apply it to my design with the help of other existing hospital who has already adapted this kind of approach or theory.

3.1.2.2 District Health Facilities Guidelines for Development and Operations

From World Health Organization Regional Publications, Western Pacific Series No. 2

3.1.2.2.1 The Article and its Relevant Information The Publication is a 367-page publication which aims to:

i. Outlines the relationship of the facilities to the district health services of which they are apart; ii. Presents a detailed outline of the planning and

design process for district health facilities, encompassing aspects of function, size, space, and staffing;

iii. Provides a detailed account of the lifecycle requirements of equipment management, together with medical and other equipment lists for different facilities and types of services;

iv. Provides an outline of how essential drugs should be selected, procured and managed;

(7)

linkages and addressing health transition; and vii. Provides an outline of the features required to

implement integrated health care and resource management processes necessary to support a district health service.

viii.

This literature will be the main foundation in creating site selection criterion. The selection of site will be through mapping of inventory and distribution of health facilities; determining service catchment area and; determining factors to be considered in locating a district hospital (which are size of the site, topography, drainage, soil conditions, utilities available, natural features and limitations). Moreover, the Master physical development will also be guided by this publication and the planning and design of the Hospital Departments and Services.

3.2 CASE STUDIES

3.2.1 Local Case Studies 3.2.1.1 Manila

3.2.1.1.1 Makati Medical Center

Figure 1: Panoramic View of Hospital Premises Source:

https://www.citibank.com.ph/global_docs/newsroom/images/1305_makati_medcity.jpg

3.2.1.1.1.1 Summary

Makati Medical Center, the leading healthcare facility in the Philippines, is a 609-bed tertiary

(8)

surgical facilities. We are committed to delivering total quality healthcare services that exceed your expectations.

Date started operations: May 31, 1969 Ownership: Privately held corporation Total building area: 50,000 sqm Floor area: 84,500 gfa

Number of beds: 524 Inpatient beds Number of newborn beds: 30 bassinets Total number of staff physicians: 811

Services:

 Acute Stroke Unit  Aesthetic Center  Aesthetic Surgery

 Allergology and Immunology  Anesthesiology

 Bone Marrow Transplant Unit  Breast Clinic  Cancer Center  Cardiac Catheterization Laboratory  Cardiology

 Cellular Therapeutics Center  Center for Tropical and

Travel Medicine (CTTM)  Clinical Psychology  CLS Eye Center

 Colorectal Surgery

 Computerized Tomography (CT Scan)  Critical Care / Intensive Care

 Delivery Room

 Department of Medicine  Dermatology

 Diabetes Care Center  Emergency Medicine  Endocrinology  Endoscopy Unit

 ENT Diagnostic Center  Gastroenterology  General Medicine  Heart Station

 Hematology

 Home Care and Hospice  Infectious Diseases

 Institutional Review Board  Interventional Radiology  Liver Care Center

(Hepatobiliary and Pancreatic Center)  Magnetic Resonance

Imaging (MRI)

 MakatiMed Health Hub  MakatiMed Health Hub

(in-patient)

 MCF DermLaser and Phototherapy

 Memory Plus Center  Neonatal ICU

 Nephrology

 Neurological Sciences  Neurology

 Neurophysiology and Sleep Disorders Laboratory

 Neurosurgery  Nuclear Medicine

 Nursing Services Division  Obstetrics and Gynecology  Oncology

 Oncology Unit  Operating Rooms  Ophthalmology  Optimal Aging Center  Orthopaedics

 Osteoporosis and Bone Health

 Otorhinolaryngology (Ear, Nose, and Throat)

 Pain Control Clinic

 Pathology and Laboratories

 Pediatric Intensive Care Unit (PICU)  Pediatric Surgery

 Pediatrics

 Pharmacy Services

 Physical Medicine and Rehabilitation  Plastic & Reconstructive Surgery  Psychiatry

 Pulmonary Diseases  Pulmonary Laboratory  Radiation Oncology  Radiology

 Renal Care Services  Rheumatology  Surgery  Surgical ICU  Telemetry

 Thoracic Cardiovascular

 TomoTherapy Radiation Treatment  Ultrasound

 Urogynecology and Incontinence Center

(9)

3.2.1.1.1.2 Architectural Analysis

(Architect Luis Ma. G. Araneta, The Master Builder,

2015)

Distinctive of all works by Arch. Araneta, Makati Medical Center was inspired by the same simple, modern, and uncluttered structural approach. His design was heavily influenced by the clean lines of the 1960s, flawless as smooth strokes of a pen on parchment. At that time, Makati Medical Center was aesthetically unparalleled.

Arch. Araneta belonged to a design era when simplicity of form combined with the convenience of function was the benchmark of modernity. With this trend, he used swooping lines, circular strokes and slender, decorative stairwells to create an edifice that stood like a sculpture amidst suburban Makati, a true expression of what was then novel architectural movement.

Like his fellow visionaries, Arch. Araneta had a visual concept for healing the sick. He knew that wellness was about creating harmony between body and spirit which required a design with an appeal to all human senses. Thus, he quickly abandoned the traditionally cold and antiseptic hospital interior and, with sheer attention to detail, added color and warmth.

Arch. Araneta worked closely with legendary beauty and socialite, Elvira Manahan, with whom he had envisioned a concept ahead of its time. They wanted an environment that would convey serenity and a warm sense of wellbeing. Having been known in social circles as arbiters of style, the tandem decorated the hallways and hospital suites with rich tones and coordinated bedding and furnishing to achieve such a space for healing. This was the

(10)

physical embodiment of creating the leading hospital in Makati.

(11)

(12)

PLANS:

(13)

(14)

(15)

(16)

(17)

(18)

Fifth to Ninth Floors are majorly Private Rooms with Central Nurse Stations.

Tenth Floor is Machine Rooms

Tower 1 has one basement used as Morgue Tower 2 has 3 Basements for Parking

Tower 3 is the Administrative Building. 3.2.1.1.1.3 Findings and Analysis

The hospital is privately owned and looks like a mall at its Ground Floor. Personally, the first 4 floors makes me dizzy because of maze like spaces, and noticeable traffic of people. What I notice about is handrails on walls provided you old users. From 4th floor onwards spaces becomes less crowded and more private.

3.2.1.1.1.4 Recommendation/Application to present study

Though it doesn’t seem related into a Provincial Hospital, my goal for studying the MMC is to compare the services it has as tertiary level and how is the facility’s condition id doing. Why a public facility has to have a brand of dilapidated, scary, bad ambience environment? Is it really the budget?

3.2.1.1.2 Ospital ng Maynila

3.2.1.1.2.1 Summary

Figure 2: Ospital ng Maynila Façade Source:

https://en.wikipedia.org/wiki/Ospital_ng_Maynila_Medical_Center#/media/File:OngMMCjf9958 _05.JPG

(19)

as training ground of health science students (students of medicine, nursing and physical therapy)

There was once a case in its history that it’s not accepting thousands of patients due to its incapacity to accept such number of people. Since then, OMMC’s admission and treatment of patients are primarily concerned to those who are bonafide residents of the city as the hospital operated and maintained through taxes paid by Manila residents. To provide comprehensive health care for the City of Manila, the hospital was organized along functional levels, namely (Profile of Ospital ng Maynila Medical Center, 2015):

A. Administration. A governing body the Board of Trustees, formulates all the general policies regarding the operation of the hospital, and recommended, for the Mayor’s consideration, the appointment of hospital staff and personnel, as well as assist in securing additional financial support for the hospital.

The members, who are appointees of the mayor, serve on a voluntary basis and not entitled to any remuneration.

B. The hospital administrator. The actual authority for the administration of the hospital is vested in its chief executive officer, the hospital administrator, who is in direct charge of its management and responsible for the smooth functioning of hospital activities. The administrator is guided by policies determined by the Board and shall coordinate effectively medical, nursing, and administrative services, in order to attain the objectives or goals of the hospitals.

C. Departmental organization.

The various departments, including both in-patient and out-patient services, are grouped under 3 major services:

1) Medical services;

Medical services consist of ten clinical departments, namely: Surgery; medicine; pediatrics; obstetrics and gynecology; eye; ear; nose and throat; out-patient; emergency; anesthesiology; pathology; and radiology.

2) Nursing services; and

(20)

nursing care to patients; the provision of education and training to its staff; the establishment of a positive program of selection and recruitment of nursing personnel; programming nursing budgetary needs; conducting of periodic standardization program in nursing; and conducting nursing research and studies. 3) Administrative services.

Other departments are administrative, engineering, and dietary services. A hospital volunteer service will shortly be organized which shall render volunteer services to assist the hospital in project like promotion of community interest, fund-raising, and other equally important undertakings.

3.2.1.1.2.2 Architectural Findings and Analysis

The Hospital looks more of a school building with parents waiting outside to fetch their son/daughter. Currently it is being renovated/ rehabilitated that’s why I cannot fully observed and criticized the spaces. But just like other public hospital like the Philippine General Hospital (PGH), its ambience is scary. It feels like an infectious place that one would like to get shower with alcohol. Hallways feels like some entity is looking at you because of dim lights. It’s beside the bay with very nice sunset but it’s not used as an advantage to have a scenic

Figure 3: Hospital Façade Source:

http://www.panoramio.com/photo_explorer#user=4955072&with_photo_id=74228241&order=date_de sc

(21)

3.2.1.1.2.3 Recommendation/Application to

present study

I don’t see anything good with it. Maybe I can use this as an inspiration on not to design something like this.

3.2.1.1.3 Philippine Heart Center

(Philippine Heart Center, 2015)

3.2.1.1.3.1 Summary

The Philippine Heart Center (PHC), designed by Architect Jorge Y. Ramos, is a state-run hospital specializing in the treatment of cardiovascular ailments. Inaugurated on 14 February 1975 by President Ferdinand E. Marcos, it was originally known as the Philippine Heart Center for Asia.

As symbolized by its four-heart logo, the Center offers a comprehensive program of patient care, education and training, research, and public information. The Center extends the best and most efficient medical services to its patients by maintaining a pool of well-trained and highly-experienced physicians and other medical personnel who utilize some of the latest in technology and procedures in cardiovascular science.

ABOUT PHILIPPINE HEART CENTER

Our Mission

Driven by our shared desire to improve the health status of the Filipino people we, the PHILIPPINE HEART CENTER, shall provide comprehensive cardiovascular care enhanced by education and research that is accessible to all.

Our Vision

The PHILIPPINE HEART CENTER is the leader in upholding the highest standards of cardiovascular care, a self-reliant institution responsive to the health needs of the Filipino people.

Our Objectives

 To provide compassionate and expert patient care.

 To provide world-class education and training.

 To conduct Internationally-acclaimed research.

 To responsibly disseminate scientific and lay information to the public.

Our Values

(22)

NINE-STORY MEDICAL ARTS BUILDING MINA DE ORO PROVINCIAL HOSPITAL AND CENTER FOR RESPIRATORY HEALTH

Application of Therapeutic and Healing Design Approaches in a Patient- Centered Health Facility

Patient-focused Care

We shall uphold the highest commitment to each one of our patients, giving each of them utmost priority and ensuring everyone has everything he needs to get well, including our dedicated care and attention.

Compassion

Our patients shall know us not only for our expertise but also for our sensitivity and compassion. We try always to remember that our patients need not just cure but healing and nurturing. Their overall wellness is what we seek. Integrity

We shall conduct ourselves in the highest standards of professionalism and ethics. We shall uphold fairness and honesty in all our dealings with our patients, partners and suppliers. We believe that it is only in so doing that we preserve our right to serve the Nation and our Countrymen.

Respect

We give what is due in every transaction or relationship. We earn respect by likewise according the respect each one deserves, not by demanding it.

Excellence

We seek excellence in everything we do by striving to be better each day. We shall be the experts in our fields of endeavor and we will not rest until we have shared this expertise with others who have the same passion for excellence. We believe our patients and the Filipino people deserves no less.

3.1.1.1.1.1 Architectural Findings and Analysis ARCHITECTURE

The Philippine Heart Center (PHC) is seated on a 2.7 hectare lot at the corner of East Avenue and Matalino Street in the Diliman District of Quezon City. It is bounded by the East Avenue Medical

Center on its side. Other landmarks within the vicinity are: Bangko Sentral ng Pilipinas (Printing and Mint Plant), National Kidney and Transplant Institute, Social Security System, Quezon City Hall, Sulo Hotel, among others. It has four (4) buildings composed of a five-story Hospital Building, the two-story Nuclear Medicine Building, the nine-story Medical Arts Building (MAB), and the two-story MAB Annex with a car park level. It also houses other offices like the Development Bank of the Philippines (1st floor) and Tariff Commission (5th floor) at the MAB.

The PHC hospital proper is a 354-bed tertiary care center. There are twenty-one nursing units, including 53 Intensive Care Unit (ICU) beds, 24 suites, 56 private rooms, a

(23)

HOSPITAL BLDG MEDICAL ARTS

PLAZA design of having 4 petals

in each floor represents the 4 chambers of the human heart.

SERVICES

Nearly a million children and adults afflicted with heart disease and related ailments have

been treated at the Philippine Heart Center since it opened its doors on Valentine’s Day in 1975. The center is organized to diagnose, treat, and rehabilitate patients of every age with every kind of cardiovascular disorder. Diagnostic support services include a hemodynamics cardiovascular laboratory, computed tomography (CT), electrophysiology, nuclear medicine, hemodialysis, and radiology. The Noninvasive Cardiac Laboratory provides complete cardiac diagnosis through inter-related noninvasive methods and procedures, such as 2D echocardiogram with color Doppler and stress (treadmill) testing. The Diagnostic Radiology Laboratory provides radiological services to patients, including fluoroscopic contrast examinations, tomogram of specific organs or structures, portable radiography and fluoroscopy, and diagnostic (non-cardiac) ultrasound. The Pulmonary Medicine Laboratory diagnoses, evaluates, and manages patients with problems in the respiratory system.

The center’s three main units are the Department of Cardiovascular Surgery and Anesthesia, Department of Cardiovascular Medicine, and Department of Allied Medical and Surgical Specialties. The hospital has six operating suites with facilities and support staff for five simultaneous open-heart procedures plus one additional simultaneous closed-heart, thoracic, vascular, or general surgical procedure.

ARCHITECTURAL ANALYSIS

The Hospital Main Building floor plan layout was similar to its logo. It was said that this logo was inspired by the

(24)

is a representation of the four chambers of a heart: two upper atria, the receiving chambers, and two lower ventricles, the discharging chambers.

Beside Petal B is a plaza which is known as the

Pagbubungkos plaza connecting to the massive nine-storey Medical Arts Building and its Annex. Petals don’t have specific area of concerned instead they group areas into floors. The planning and Grouping of areas will be discussed in the later pages of this study.

DESIGN PHILOSOPHY

“It is great architecture when everything you do in a building is somehow enriched because of the design of the space. The building sublimates your activities, no matter how mundane those activities are.”

In architecture, function is what dictates design, and function is about satisfying human needs. What makes the outside of a building beautiful is a result of what goes on inside.”

– Ar. Jorge Ramos DESIGN CONCEPT This building is one of the modern building during the time of Marcos Administration. The massive facade, speaks to its integrity itself.

Considering its function, Ramos built the medical arts building as a buffer

between the noisy, dusty street and the hospital with a courtyard in between. It was also the first smoke-free building and the first time an operating table was also the patient’s bed. The day before the surgery, the patient is being prepared on the bed. It is the same operating table wheeled into the operating rooms. Also, patient rooms encircle the nurse’s station for easier accessibility in case

of emergencies.

(25)

GROUND FLOOR AND BASEMENT Food Services

Cafeteria. The 1475 Cafeteria and its Extension at the Basement provide a variety of snacks and meals for visitors and watchers. The Main Cafeteria is open daily from 6:00 a.m. - 7:00 p.m. and the Extension is open 24 hours except Sundays. Cleaning time at the main cafeteria is from 2:00 p.m. 3:00 p.m. and 4:00 p.m. -5:00 p.m. at the Extension.

Other Facilities and Services

Pharmacy. The Pharmacy at the Basement is open to the public from 8:00 a.m. - 5:00 p.m. Mondays thru Saturdays. The Pharmacy Extension on the 4th floor of the Medical Arts Building is open from 10:00 a.m. - 5:00 p.m. Mondays thru Fridays.

Pastoral Services.

Ecumenical chapel. The Center maintains an ecumenical chapel at the penthouse of the hospital and the services of a Catholic Hospital

Mourge.

Mourge is located at the basement Public Services

Information. The PHC management set up a Customer Relations Division with three sections: Public Assistance Information Unit, Customer Care Concierge and Patient Business Office which provide effective frontline services

(26)

transparency and simplifying procedures that will expedite transactions.

Admission

The Admitting Section is responsible for providing a systematic and orderly process of admitting patients to the Center by securing all information pertinent

to the patient's purpose of ensuring the accurate reporting of admissions and discharges. It also provides accurate and complete information on admission requirements, hospital rules and guidelines, and other hospital activities.

Medical Services

Outpatient Division. The Out-Patient Division is responsible for the evaluation and management of cardiac patients under social service category using simple and diagnostic techniques. It also functions to delineate cardiac cases from non-cardiac cases for the institution of appropriate management and treatment. Its Consultation Clinics provide continuous medical, surgical, pulmonary follow-up for cardiac patients. In addition, it maintains the Center's Employees Infirmary Clinic.

Emergency

The Emergency Room is responsible for rendering initial and emergency and out-patient service (diagnostic and consultation) to those with cardiac and other related conditions. It

also provides

emergency care for cases that cannot be admitted to the Center before rendering them to other facilities; and whenever necessary, coordinates medico-legal cases with proper agency.

The newly renovated Emergency Room is a 20-bed facility. It has an 8-bed observation unit, a 7-bed chest pain center, 3 consultation cubicles, and 2-bed surgical room. Diagnostic and Laboratory Services

Renal and Hemodialysis Section. The Renal and Hemodialysis Section is responsible for the evaluation, diagnosis, and management of patients with acute or chronic renal failure. The section has ten hemodialysis machines that service two shifts of out-patients and all in-patients with peri-operative renal failure.

(27)

evaluates and precisely diagnoses patients thru the use of invasive procedures such as cardiac catheterization including hemodynamics and angiographic studies.

Invasive Cardiovascular Laboratory. The Non-Invasive Cardiac Laboratory is responsible for providing complete cardiac diagnosis through inter-related non-invasive methods and procedures such as 2D Echocardiogram with Color Doppler and Stress (Treadmill) Test. Accurate diagnostic evaluation forms the basis of the rational therapy which will minimize morbidity and mortality.

Pulmonary Medicine. The Pulmonary Medicine Laboratory is responsible for the diagnosis, evaluation and management of patients with problems in the respiratory system, and undertakes diagnostic procedures for proper identification of causative factors and therapeutic modalities appropriate to the diagnostic results. It also administers inhalation devices such as aerosol treatments, ultrasonic nebulization and incentive spirometers, and performs all pulmonary function laboratory procedures such as spirometry, lung volumes, diffusion, nitrogen wash out, and arterial blood gas analysis

Diagnostic Radiology. The Diagnostic Radiology Laboratory provides radiologic services to patients including fluoroscopic contrast examinations, tomogram of specific organs or structures, portable radiography and fluoroscopy, and diagnostic (non-cardiac) ultrasound. Computed Tomography Scan.

The Computed Tomography Scan Section is an adjunct of the Radiology Division in addition to Ultrasound and conventional Radiology. SECOND FLOOR Electrophysiology Laboratory, PETAL B. The Electrophysiology Laboratory provides diagnostic

and therapeutic

management/treatment of patients with arrhythmia and arrhythmia related disorders. PETAL B

(28)

Hospital Wards PHC has twenty-one patient care units situated in the hospital bldg, except for petals 3D, 3E, 3F which are in the 3rd floor MAB.

Suites at the fourth floor and private

rooms on the third floor are equipped with the following: dressing room/closets, bathroom, refrigerator, television set and telephone.

MEDICAL ARTS ANNEX BUILDING GROUND FLOOR

Peripheral Vascular Laboratory

The Peripheral Vascular Laboratory is responsible for the management, care and follow-up of patients with peripheral vascular problems by administering non-invasive procedures involving cerebrovascular, peripheral arterial, and venous techniques.

Blood Bank

The Atomic and Clinical Pathology is responsible for the performance of the clinical and anatomic pathology procedures, to include the collection and transmittal/referral to the appropriate laboratory of specimen for procedures

which are beyond the capabilities of the department. The Anatomic Pathology Section examines all human tissues and fluids for histopathological and cytological studies; performs special studies in cardiac lessons and updates the cardiovascular registry.

Food. Red Ribbon, Jollibee and Chowking are located at the MAB Annex. Deli France Cafe and Heart Throb store are located at the Pagbubungkos Plaza.

Bank. The Development Bank of the Philippines is at the ground floor of the Medical Arts Building. It is open on weekdays from 8:30 a.m. - 3:30 p.m. The ATM machine is open 24 hours.

(29)

are all situated at the Second Floor of the Medical Arts Buiding.

THIRD- FIFTHTH

FLOOR

Hospital Wards and Diagnostic/Laboratory Services SIXTH FLOOR

Medical Records. Request for medical certificate, clinical abstract & filling up of insurance forms, etc.; request for photocopies of clinical abstracts, ER-soap, operating room records, anesthesia report, death certificates, and diagnostic test results

SEVENTH FLOOR

Pediatric Play Area.

To aid children who underwent heart surgery towards recovery, the Play It Forward play space at the Philippine Heart Center is designed to be a place where

they can engage

in physical activities. Total floor area is 110sqm; 60sqm interiors with a capacity of 10-15 patients

Psychiatry and Behavioral Medicine Section. The Psychiatry and Behavioral Medicine Section / Cardiac Health Education, Enhancement, and Restoration Service (CHEERS) Program is responsible for helping surgical candidates prepare psychosocially for operation; specifically, to enhance ability to cope with pre-surgical stress, to educate about diagnosis, treatment plan, and prognosis, and to strengthen motivation and sense of responsibility for the success of the surgery.

EIGHTH FLOOR. This floor is dedicated to all Rehabilitation programs for Patients

Cardiac Rehabilitation. The Physical Medicine and Rehabilitation Section provides rehabilitation services to the community and public with the best facilities in rehabilitation medicine, and gives the best treatment to patients with disability or functional impairment in an integrated, coordinated and individualized manner. Likewise, it prides itself with the biggest oval track and world-class facilities for cardiac and physical rehabilitation of patients among hospitals in the Southeast Asian region HRD Office. Trainings and Programs or after grad programs are also being offered in this hospital.

(30)

3.1.1.1.1.1 Recommendation/Application to

present study

Hospital is somewhat centrally designed, having medical staffs being surrounded by patients. It shows connectivity and easy access. The planning of spaces, putting most diagnostic at the lower floors and treatments at the higher floors. The concept of time frame is very important in Hospital planning to avoid crowding at one place. This concept of circulation and access system of three main users of the hospital will be studied for the use of 300 bed Hospital plate.

3.1.1.2 Oriental Mindoro

3.1.1.2.1 Oriental Mindoro Provincial Hospital

3.1.1.2.1.1 Summary

Oriental Mindoro Provincial Hospital is a Level 1-Provincial Hospital with 100 beds located at Calapan City, the capital of the province.

3.1.1.2.1.2 Service Analysis

 General Administration and Support Services

 Operations  Medical Services

o Medicine

o Surgery (Major and Minor) o OB-Gyne

o Newborn

 Laboratory Services  Dental Services  Nursing Services

 Patient Support Services

o Medical Records Services

o Nutrition and Diabetics Services o Pharmacy Services

(31)

3.1.1.2.1.3 Application to Study

To identity existing services to avoid duplication and to know which service is not yet available in the province yet is in need of.

3.1.1.2.2 Pinamalayan Community Hospital

3.1.1.2.2.1 Summary

Pinamalayan Community Hospital is an Infirmary level Hospital with 10 beds. Currently, it’s under expansion/upgrading into 25-bed Level 1 Hospital 3.1.1.2.2.2 Service Analysis

 General Administration and Support Services

 Operations

 Medical ,Dental, and Laboratory Services o Medicine o Surgery o OB-Gyne o Newborn  Laboratory Services  Dental Services  Nursing Services

 Patient Support Services

o Medical Records Services

o Nutrition and Diabetics Services o Pharmacy Services

o Medical Social Services

 Other Health Related Services

o Blood Letting o Medical Mission 3.1.1.2.2.3 Application to Study

(32)

3.1.2 Foreign Case Studies

3.1.2.1 Michigan, U.S.A.

3.1.2.1.1 Henry Ford West Bloomfield Hospital

3.1.2.1.1.1 Summary

PROJECT AT A GLANCE

Client: Henry Ford Health System Architect: Kahn

Location: West Bloomfield, MI

Attributes: Building Information Modeling (BIM), Healthcare, LEED Certified, Green Building, Turner

Logistics: Procurement Services, Michigan

According to GetWellNetwork.com:

Since opening its doors in 2009, Henry Ford West Bloomfield Hospital has partnered with GetWellNetwork, provider of the industry’s leading interactive patient care (IPC) solution, to create a dynamic, unique patient experience and fulfill the organization’s vision to become a “hospital like no other.”

Henry Ford West Bloomfield Hospital is an all-private-room hospital that opened in 2009 with

191 beds, and an additional 109 beds set to open in 2012. The hospital offers comprehensive medical care, including 24-hour emergency care, neurosciences, women’s and children’s health, orthopedics, diagnostic testing and a wellness center with complementary therapies. Henry Ford West Bloomfield Hospital is a part of the Henry Ford

(33)

The Experience Starts Right at “Check-In”

The patient experience begins immediately when patients are first admitted to the hospital, and a concierge greets them in their room. The rooms themselves are designed to further enhance the patient experience at Henry Ford. For instance, they are designed for privacy, a quieter stay with fewer interruptions, and with work alcoves for the healthcare team. There is also space for families, upholstered headboards, smart technologies, individual wardrobes with security locks, and bathrooms with easily accessible showers and sleek, curved walls. “Our goal at Henry Ford West Bloomfield Hospital is for everyone who enters our doors to feel like they are a guest,” says Gerard van Grinsven. “We know that if we don’t want our guests to feel like patients, then our hospital should not feel like a hospital. And it doesn’t.”

Departments

 Behavioral Health Services  Cancer Care

 Demonstration Kitchen  Emergency Medicine  Gynecologic Surgery

 Heart & Vascular Institute at West Bloomfield Hospital

 Heart Attack Symptoms  Heart Smart® Screening

 Henry Ford at Home - West Bloomfield  Mammography and Breast Health  Neurology and Neurosurgery  Orthopedic Surgery

 Otolaryngology - Head & Neck Surgery  Pain Center

 Patient Testimonials

 Physical & Occupational Therapy

 Radiology Services at West Bloomfield Hospital  Schedule a Follow up Appointment

 Senior Service at West Bloomfield Hospital  Stroke Program

 Surgery, Minimally Invasive and Robotic

 The Greenhouse at Henry Ford West Bloomfield  Vattikuti Urology Institute

 Vita hair salon  Vita wellness center

 Wellness Center Guidelines  Women's Health

Expertise

 Bariatric Surgery

(34)

 Organ Transplantation  Orthopedic Surgery

 Urology

 Wellness

Other than the hospital itself, the henry Ford West Bloomfield Hospital also have other facilities that act as a support to the health and wellness service the hospitals itself offers. It has a Greenhouse where they get their patient food. They also have facilities for yoga. And facilities that are accessible for al, patient or non-patient such as the café. Lodging is also not a problem in this hospital for the patients’ family and caretakers for the hospital itself is surrounded by different Inns, Hotels and Suites.

(TURNER CONSTRUCTION, 2015) The 614,000 square foot 192-bed hospital is surrounded by natural woodlands and wetlands to enhance the healing environment. A new central utility plant and 40 acres of site work was featured in Turner’s scope of work. All patient rooms are private and incorporate principles of “Feng Shui”. Windows overlook a pond and landscaped courtyards create a calm, healing, and quiet environment for patients. Comfortable hotel-like rooms also have a bed for a family member. Each patient room includes a flat panel television, internet access, and computerized patient information.

According to William J. Calmar, a writer for Quality Digest Magazine, who had visited the hospital and wrote an article about it entitled, Henry Ford West Bloomfield: More Than a Hospital, An Environment. He described his experience through the hospital as well as the quality of patient care that it offers. Here’s what he said.

 Upon approaching the hospital, you immediately struck by the beauty of the facility. Evidently, the architectural footprint for the building and the grounds were copied from various northern Michigan resorts. The lake and the well-manicured lawn is inspiring and certainly must alleviate fears of patients as they motor into the mammoth parking lot. Valet parking is also provided.

 The welcoming entrance to the hospital resembles that of a luxury hotel. Upon proceeding through the doors, you are greeted by a hostess who cordially provides directions or answers questions.

 Once inside, Van Grinsven’s vision and goal of creating an atmosphere that “takes health and healing beyond the boundaries of imagination” is quickly seen. The corridors are lined with ample signage and you never travel more than a few

(35)

A slow journey down one of the hallways to admire the various shops took me to the cafeteria. There are no deep fryers or freezers in this facility—the food is fresh and healthy. It is called “Henry’s” to reflect the name of the hospital.

 Food classes for those in the community are held regularly; and there is a possibility that The Food Network will be televising a segment sometime next year from the kitchen, which serves as an auditorium for various presentations.

 The cafeteria is such a hit that every day more than 200 people from the community, who have no direct connection to a patient, choose to dine in the facility. My lunch was excellent, healthy, and moderately priced.

 The facility boasts its own greenhouse where fresh vegetables are grown and incorporated into the menu.

 Summer concerts are held on the mammoth grounds and people are encouraged to come for picnics on the luscious grounds.

 Each patient has a private room. Now in some minds this may seem excessive but consider this— the hospital is releasing patients a half-day earlier than any other hospital because there are fewer infections. Thus patients leave sooner and few return for other symptoms. In fact, the patient satisfaction rate measured by Press Gainey is 99 percent—the highest in the industry.

 Turnover at the hospital is at 5.5 percent, while many other health care facilities experience a 35-to 40-percent turnover rate. This gets back 35-to the selection process. People with the talent for the position, placed in a position where they can perform successfully and admirably, and are happy and content.

 With all these innovative features around service, the hospital’s core strengths remain around providing clinical care that is the very best available. Physicians from various disciplines embrace the concept of team medicine and work together to offer multidisciplinary care centers including neuroscience, cancer care, digestive disorders, woman’s and children’s health, heart care, and many more. And as part of the nationally respected, fully integrated Henry Ford Health System, the hospital offers access to cutting-edge

(36)

 If you are a patient, you quickly become accustomed to 24-hour room service.

Each Wednesday, farmers and vendors are invited to display their fresh fruits and vegetables along a cobblestone street inside the hospital. On my visit, all the vendors were doing a brisk business.

Green Elements:

- Water-retentive plantings on the roof, which reduce heating and cooling costs

- A rainwater garden for improved water quality - A comprehensive recycling system

- Energy-efficient heating and cooling systems. - Living Green spaces

3.1.1.1.1.1 Findings and Analysis

These living green spaces can be integrated into nearly any hospital or clinical setting. Many facilities concentrate healing gardens in atriums or entryways; however seating areas, collaborative spaces and corridors can also serve as ideal venues for containerized installations. According to Pliska, Planterra designers have even converted defunct interior fountains into lush gardens.

AERIAL PERSPECTIVE

Henry Ford West Bloomfield Hospital is truly designed to be a Hotel for sick so as they say. It had become successful to develop a non-clinic environment in hospital without sacrificing quality medical care. In fact the design helped in the wellness improvement of all the people in the development not just the patients. Truly, this is not just a hospital but an environment, a community of wellness. Where one can go and appreciate the place just by going on their retail “main street”, have a seat on a café, or even watch a concert. This place really shows true well living.

(37)

For many hospitals and clinics, reducing recovery times, decreasing stress and cultivating happier employees tops the institutional wish list. However, rather than hiring consultants and instituting wellness programs, many facilities are opting for a more natural approach. The 300 bed Hospital plate will be inspired by the Henry Ford West Bloomfield Hospital idea of designing a hospital as a place definitely conducive for healing and healthy living where one will not feel being in an infirmary. It’s like a hotel for sick people, a non-clinic environment.

3.1.1.2 California, U.S.A.

3.1.1.2.1 Community Hospital of the Monterey Peninsula

(Community Hospital of the Monterey Peninsula, 2015)

3.1.1.2.1.1 Summary

Community Hospital of the Monterey Peninsula, founded in 1934 and located at 23625 Holman Highway in Monterey, has grown and evolved in direct response to the changing healthcare needs of the people it serves.

It is a nonprofit healthcare provider with 258 licensed hospital beds and 28 skilled-nursing beds, delivering a continuum of care from birth to end of life, and every stage in between.

(38)

It serves the Monterey Peninsula and surrounding communities through locations including the main hospital, outpatient facilities, satellite laboratories, a mental health clinic, a short-term skilled nursing facility, Hospice of the Central Coast, and business offices.

OUR MISSION

Community Hospital of the Monterey Peninsula is dedicated to identifying and meeting the changing healthcare needs of the people of the Monterey Peninsula and surrounding communities.

We are committed to providing high-quality services at a competitive cost and within a safe environment. We provide educational and public service programs to enhance the health of our community and the competence of those who provide the service.

We are committed to caring for all who come through our doors, regardless of ability to pay, to the fullest extent allowed by law and available resources.

The hospital offers a variety of treatments and specialties which include:

 Anesthesiology

 Bone and joint conditions  Breast disease  Cancer  Cardiology  Dentistry  Dermatology  Diabetes  Genetics  Heart disease  Hematology  Mental illness  Neurology  Obesity  Pediatrics  Pregnancy  Sleep disorders  Substance abuse GUIDING PRINCIPLES

1. Patients come first. Their individual satisfaction with our services is the best measure of our success. In every decision, seek to meet their needs above all others.

2. Our employees, medical staff, and volunteers are our most important organizational resource.

(39)

3. Broad community participation in our programs is essential. Cultivate thoughtful and active governance, dedicated volunteers, involvement in program planning and assessment, and enlightened philanthropy.

4. An atmosphere of support and openness encourages innovation. Promote the free exchange of ideas at all levels of our organization.

5. Quality can be continually improved in an atmosphere of support and openness. Strive to improve service quality by assessing and improving those governance, managerial, clinical, and support processes that most affect patient outcomes. Promote the free exchange of ideas and interdisciplinary communication as critical means to this end. Reward full participation in the improvement of our organizational performance. 6. Quality care must be affordable. Through the prudent application of resources, deliver excellent programs and services that represent a good value for our healthcare consumers.

7. Be a significant, positive force in our community. Provide quality services to improve the health of our community and the competence of those who provide healthcare services; become personally involved in community affairs.

8. Caring is as important to quality healthcare as technology. Empower patients and their families to participate in their healthcare by being sensitive to their experiences, privacy, and dignity.

9. Facilities and policies should be designed to enhance the healing process. Both should be periodically expanded and updated to meet the growing needs of the community.

10. We are committed to preserving and enhancing the environment. Our purchasing, operational, and disposal practices must contribute to the long-term health and viability of our beautiful region.

11. Provide financial resources sufficient to meet the present and future healthcare needs of our community.

12. Responsibility and honesty are essential. We require the highest standards of ethical behavior, not only of ourselves, but of our colleagues as well.

(40)

13. Do the right thing. Compliance with all applicable laws and regulations is a cornerstone of our duty to ourselves, our patients, and those with whom we work.

Formal name of project: Community Hospital of the Monterey Peninsula, Pavilions Project

Location: Monterey, California Gross square footage: 290,000 sq.ft. (200,000 sq.ft. new; 90,000 sq.ft. renovation) Total construction cost: $170 million

Completion Date:

South Pavilion – October 2006

Forest Pavilion – February 2007 Renovation – May 2010

(projected) Owner:

Community Hospital Foundation Architect: HOK 9530 Jefferson Blvd. Culver City, CA 90232 PH: 310-838-9555 Fax: 310-838-9586 Figure 4: Hospital Source: http://www.chomp.org/app/files/public/5685/CHOMP-horizontal.png

(41)

Figure : Aerial (left), Site Development (Top)

Source: http://www.hok.com/design/type/healthcare/community-hospital-of-the-monterey-peninsula-pavilion-expansion/

According to the designer’s website

(www.hok.com/), Healthcare Business & Technology

named this community hospital one of the “25 most beautiful hospitals in the world.”

HOK designed an expansion that doubled the size of the hospital while adding state-of-the-art technology based on the modern care protocols. Completed through a design-build delivery model, the project included a 200,000-sq.-ft. new building and a 90,000-sq.-ft. expansion.

Architectural Record reported that HOK’s major design challenge was “maintaining the Zen-like peacefulness and iconic design of a complex that has become a fixture in the community while carrying out such an extensive enlargement and modernization and adhering to the incredibly strict regulations of the Office of Statewide Health Planning and Development.”

A new patient bed wing and diagnostic and treatment center feature 100 percent single-bed, multi-acuity patient rooms developed around a series of healing gardens.

(42)

department, a new emergency department, a renovated and expanded radiology department, support services, mechanical plant and structured parking.

The design helps patients relax. CHOMP overlooks the Pacific Ocean and Monterey pine forests. This expansion blends into the environmentally protected area while maintaining the character and integrity of the original facility, designed by architect Edward Durell Stone.

Exterior Perspectives

Figure 5: Exterior Spot Perspectives Source:

(43)

California coastal zone, with significant building limitations imposed by the California Coastal Commission.”

- Dr. Steven Packer CEO, Community Hospital of the Monterey Peninsula

Excerpt of an article from the August 2008 edition of Architectural Record:

The Community Hospital of the Monterey Peninsula, or as it is fondly called by locals, CHOMP. Stone’s Wrightian, ornamented-white-concrete Modernist structure, with its focus on natural light and views of the surrounding landscape of Monterey Pines overlooking the Pacific, was completed in 1962. The low-lying, orthogonal-planned complex has landscaped courtyards, a central fountain court, overhanging roof planes for shade, single-occupancy rooms with large windows overlooking the landscape, and large skylights, all bucking the then-emerging trend of new hospital towers and focusing on context rather than maximizing interior space. The hospital has undergone several small interventions and expansions, but almost 50 years

(44)

and technology. Following an extensive interview process, the hospital’s board chose HOK’s Los Angeles office for the task, asking the firm to maintain the character of the original design, which patients and the community have come to cherish. HOK’s $170 million addition to the hospital consists of about 200,000 square feet of new construction and 90,000 square feet of renovated space. New spaces are complete, while the renovations will continue until 2010. Three-story additions include the Forest Pavilion, a new patient wing projecting north on the site of the hospital’s former rose garden; the South Pavilion, a new diagnostic and treatment wing (containing a new ICU, emergency departments, cath labs, and imaging) to the south, on the site of the former doctors’ parking lot and support structures; and a new, three-level underground parking-garage area, nicknamed the “garage mahal,” under the renovated and expanded main entrance area. Existing spaces undergoing renovation include the hospital’s cafeteria, imaging facilities, cath labs, administrative offices, a meditation room, a new cardiopulmonary department, a rehab gym, and service and support spaces.

THE PRODUCTS

Structural system: Cast in place reinforced concrete Exterior cladding: Concrete: Granite Rock

GFRC Wall panels: Dura Art Stone, Roofing: Single Ply: GenFlex

Windows: Steel: Curries (built-up hollow metal) Aluminum: Kawneer

Glazing:

Glass: French Glass/Signature Glass; Firelite (Techincal Glass Products)

Skylights: Kawneer

Doors:

Entrances: Kawneer Metal doors: Curries Wood doors: Buell Door Co.

Fire-control doors, security grilles: Cookson Special doors (sound control, X-ray, etc.): Nelco

Hardware:

Locksets: Schlage

Hinges: Architectural Builders Hardware Closers: Norton

Exit devices: Von Duprin

Pulls: Architectural Builders Hardware Security devices: Von Duprin

Cabinet hardware: Sugatsune

Interior finishes:

Acoustical ceilings: Armstrong Suspension grid: Chicago Metallic

Cabinetwork and custom woodwork: Mission Bell Paints and stains: Sherwin Williams

Wallcoverings: Maharam – Whirlwind Paneling: Natural Cherry Veneer Plastic laminate: Formica Special surfacing: Zodiac Quartz

Floor and wall tile: Patient, Staff & Public Restrooms Resilient flooring: Forbo Linoleum, VCT, Altro Carpet: Custom Rugs – Decorative Carpets

(45)

(46)

(47)

(48)

3.1.1.2.1.3 Findings and Analysis

The new complex is

most notable for how

it blends in. While updated with the latest technologies, the plan, massing, and scale of the new buildings are almost identical to those of the original buildings. To add space without altering the horizontal nature of the complex, the firm excavated one to two levels down on both ends of the hospital, aligning the new buildings with the old. Maintaining low ceiling heights while fitting new HVAC and electrical systems also required innovative rerouting. Main ducts skip the building’s middle level, which is instead fed via smaller branch ducts from the other floors.

Despite of being a non-profit/ public hospital, its spaces, design and ambience seems like a private hospital which is very well maintained. Unlike public hospital especially in the Philippines, this facility

(49)

Mangyan carvings to show an Iconic, Culture-oriented building. And also, the use of water features to soothe and calm the surroundings. Since the proposed site is slightly below grade compare to the road. I will raised the structure then make the substructure a bio retention area which will double as a treatment system and passive cooling system to the superstructure.

The Healing Garden which will be the center or focused of the design will also be adapted. On (proposed) site is a Medium Size Mango tree and some shrubs which will be preserved and be the location of the healing garden which will have access to the bio retention below.