Hospital Design Principles

Policy and Service Context 1 Purpose This document has been developed as part of a suite of guidelines, norms and standards for healthcare facility planners and designers both to indicate specific requirements to be met in the development of new and the upgrading of existing healthcare facilities for the public sector in South Africa, and to provide context for planners and designers. This document focuses on the form of the hospital and is supported and enabled, as indicated in section 2 below, by a range of other more focussed guidelines. 2 Overview Hospitals provide the primary setting for the delivery of health care services. For patients the setting is important – patients expect an environment that will enable effective treatment for their condition, that will be pleasant and promote healing and that will be safe. While patient episodes of care are generally infrequent and of relatively short duration, the quality of the environment and experience can significantly influence both their physical and mental wellbeing as well as their rate of recovery. In contrast the hospital environment is the permanent place of work for staff. Their experience must ensure that they are enabled to carry out their duties in the most effective way possible. Good quality environments can positively enable delivery and lead to more effective patient outcomes while poor quality environments can lead to patient and staff frustration, both compromise service delivery and patient outcomes and increase the cost of service delivery. This document is designed to provide a frame of reference for the planning and design of the whole hospital; at one level it provides the introduction to the suite of IUSS Guides, Norms and Standards (IUSS-GNS) for healthcare facilities, at another it synthesises the common requirements of all documents, providing the glue that links all the many clinical and support departments and services that make up the complex organism that is the hospital. The Hospital Design Principles Guide is one of a set of 46 work packages making up the suite of IUSSGNS documents. The set of documents was structured into four broad subsets: • Clinical and clinical support departments where there is direct contact between the patient and hospital staff • Support departments providing administration, hospital support or facilities management services enabling the primary clinical services • Cross cutting documents which impact many or all departments, and • Procurement related documents including toolkits and guides impacting the planning, briefing, acquisition, commissioning, maintenance and decommissioning of healthcare facilities. Many of these documents are interrelated and in order to avoid duplication information is located primarily in the document related to the primary function. Cross reference is made to documents where topics common to more than one department or unit are covered in more detail. For example specific requirements for infection prevention and control (IPC) will be highlighted directly where applicable, such as in the surgery or out-patient services documents but as IPC is critical across all healthcare facilities, the subject covered more thoroughly and in more detail in the IPC document.

Table 1 below lists the full suite of documents and the key cross reference documents for the hospital design principles document. A: CLINICAL B: SUPPORT C: CROSS CUTTING D: PROCUREMENT A:01 Accident and emergency X B:01 Administration and related services X C:01 Generic room data X Integrated infrastructure D:01 planning (IOPT toolkit) A:02 Critical care X B:02 General hospital support services X Hospital design C:02.1 principles D:02 Planning and briefing x A:03 Adult in-patient services X B:03 Catering services X C:02.2 Security X D:03 Space guidelines X A:04 Laboratories X B:04 Laundry and linen X C:03 Engineering design principles (BES) X D:04 Cost guidelines X A:05 Mental health services x B:05 Mortuary X C:04 Environment and sustainably X Order of Magnitude D:04.1 (OoM) estimator x A:06 Obstetrics & gynaecology X B:06 Nursing education institutions (NEI's) C:05 Materials and finishes X Department level D:04.2 estimator X A:07 Oncology X B:07 Health facility residential x C:06 Future healthcare environments x D:04.3 Life cycle costing X A:08 Outpatient services X B:08 Central sterile supply unit X C:07 Healthcare technology x D:05 Procurement A:09 Paediatrics and neonatology X B:09 Clinical training x C:08 Inclusive environments X D:06 Commissioning x A:10 Pharmacy X B:10 Waste disposal X C:09 Infection prevention and control X D:07 Maintenance x A:11 Primary health care C:10 Health informatics x D:08 Decommissioning x A:12 Diagnostic radiology X C:11 Regulations x D:09 Capacity development A:13 Rehabilitation & allied services X A:14 Sub-acute services x A:15 Operating theatres X A:16 TB services X Table 1: IUSS guidelines and interdependencies This document outlines the policy and service context for a hospital project as well as providing detailed requirements and context for planning and design decisions that need to be considered during the development process. The document is divided into 3 main sections: • Part A outlines the national and provincial service and policy context and briefly covers the key factors impacting on design development • Part B covers more specific planning and design requirements through the various stages of design development and includes issues common to most hospital departments, while • Part C includes schedules for further reading and references. This document is designed to fulfil two primary functions: • firstly to act as a primer for healthcare facility planners and designers providing both background and contextual information on hospital design principles as well as references for further reading, and • secondly to list specific requirements that the design team need to adhere to. Sections which act as a primer are shown in normal font text, while those serving as specific requirements are highlighted in italic text and are listed under the relevant section. 3 Policy and service delivery context 3.1 Healthcare infrastructure and healthcare systems The primary function of a health care system is to deliver services that will contribute towards the health and wellbeing of the community served. Facilities are part of the healthcare service system and require a set of allocated resources – including people, buildings, equipment drugs and supplies to operate effectively. The ability of the system to operate depends equally on the quality and effectiveness of the stewardship and oversight and on available and allocated funding. The make-up of a particular facility depends on the defined service to be delivered as well as services provided from or shared with other related facilities (such as referred clinical services, breakdown and prepacking in the pharmacy for linked clinics or outsourcing laundry services). This must be defined in the project brief.

Figure 1: Health system performance framework Healthcare facilities provide the environment through which healthcare services are delivered over the full life cycle of the asset. Facilities, usually with a life span of up to 50 years, are the most fixed component and therefore also potentially the most constraining aspect of the health care delivery system. Quality assets can positively enable the service; equally poor facilities can negatively impact service delivery. The more effectively the service is planned, defined and resourced the more likely that individual projects can be developed to provide an effective foil for service delivery. The better and more experienced the team deployed to a new or upgrade project, the more likely the resultant facility will be both enabling and resilient over time. The context for service delivery for the specific facility that the professional team is tasked on, will be developed from the provincial Service Transformation Plan into the project brief. 3.2 Policy Health service delivery in South Africa is provided under the framework of the National Health Act Regulations

Include ref and cross ref to regulations here? 3.3 National Health Insurance (NHI) Requirements: A. The design of all healthcare facilities must allow for the provision of the required range of services envisaged under NHI and must be patient friendly, robust and sustainable over their planned service life. “South Africa is in the process of introducing an innovative system of healthcare financing with far reaching consequences on the health of South Africans. The National Health Insurance commonly referred to as NHI will ensure that everyone has access to appropriate, efficient and quality health services. It will be phased-in over a period of 14 years. This will entail major changes in the service delivery structures, administrative and management systems.” (HST.org.za, 2014) In the service delivery model outlined in the NHI Green Paper (2012) NHI services will be provide through all existing healthcare facilities in South Africa supplemented where appropriate. Services will potentially be delivered from both the public and private sectors with the bulk of services continuing to be provided through the government network of facilities. Significant work will be required to ensure that all facilities can cater for the expanded range of services envisaged under NHI, to bring facilities up to the standards required and ensure that they can be readily and cost effectively managed and maintained at the required standard. Standards will be monitored by the Office of Standards Compliance. 3.4 Measuring performance 3.4.1 National Core Standards for Health Establishments in South Africa (NCS) Requirements A. Healthcare facilities must comply with the National Core Standards (NCS) set by the Office of Standards Compliance (OSC). As healthcare facilities will be assessed from time to time to review ongoing compliance as set out in the NCS, it is essential that planners and designers are acquainted with these requirements and plan and design accordingly. The NCS (Republic of South Africa, 2011) were developed by the DoH to assist in setting the benchmark of quality healthcare against which delivery of services can be monitored. It addresses various aspects related to safety and security issues, particularly in the following two sections of the document: • Domain 2: Patient Safety, Clinical Governance and Clinical Care covers how to ensure quality nursing and clinical care and ethical practice; reduce unintended harm to healthcare users or patients in identified cases of greater clinical risk; prevent or manage problems or adverse events, including healthcare associated infections; and support any affected patients or staff • Domain 7: Facilities and Infrastructure covers the requirements for clean, safe and secure physical infrastructure (buildings, plant and machinery, equipment); functional, wellmanaged hospital services; and effective waste disposal (See Annexure B). 3.4.2 Project assessment Requirements A. The most significant impact on the functioning and operation of the proposed service is usually achieved through effective planning and design of the new facility or upgrade project. Generally the more quality time that is invested in project initiation and development the better the outcome will be. Project plans and designs will be assessed during their development at the approval gates indicated in the Project Implementation Manual and as outlined in figure xx below. Gateway process Design assessment framework Post occupancy evaluation Performance monitoring