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Posted at: May 17, 2017, 12:26 AM; last updated: May 17, 2017, 12:26 AM (IST)HOSPITAL ENGINEERING & ARCHITECTURE

Healing designs

Usha Albuquerque

The Indian healthcare sector is growing at a tremendous pace strengthening its reach and coverage as well as services in public and private hospitals, nursing homes, clinics - urban and rural, and diagnostics centres.  With a requirement of 6,00,000 to 7,00,000 additional beds in the next five to six years it is predicted that the Indian healthcare market, will grow 23 per cent by 2020. 

Along with growth comes the need for providing enhanced medical services and care to an ever increasing population. However, most hospitals today are bursting at the seams — known for their lack of sanitation and basic infrastructure like beds and medical facilities. Space is tight, lifts not working, clogged toilets, patients waiting for hours to see a doctor in unhygienic conditions, poorly stored medicines, unclean wards and torn beds. While private hospitals can boast better hygiene, with billions of dollars being invested annually in health care facilities, the facility design of the hospital, with its equipment and technology, has not often been considered with its impact on the quality and safety of patients. 

Courses

The Institute of Hospital Engineering was set up to promote, develop and disseminate hospital engineering and technology and educate specialist hospital technologists. The purpose is to promote healthcare facility engineering/ management through the certification of qualified and experienced individuals at different levels. For this purpose IHE has developed two programmes to be conducted concurrently as companion courses, with content that may be common, but application and emphasis which will be different. The two proposed courses are :

n Master’s degree programme in Health Facilities Planning & Designing (MHFPD) with emphasis on architectural design, ergonomics, sustainability, patients environment etc.

Eligibility: Bachelor's degree or equivalent in medicine, architecture, town planning, engineering, dentistry, nursing ect)

n Master’s degree programme in Health Facilities Engineering and Management (MHFEM) with emphasis on engineering services, asset management, infrastructure, and project/ construction management.

Eligibility: Bachelor’s degree or equivalent in any branch of engineering/technology. 

These courses  developed by the Institute of Hospital Engineering under the umbrella of the National Institute of Healthcare Engineering and Architecture (NIHEA) will assist health facilities planning and all aspects of infrastructure development. These will be joint degree programmes with faculties of medicine, planning, engineering and management, utilising their innate strengths. Students will study in a variety of campuses: Medical Architecture Research Unit (MARU) , now South Bank University, London; Health Design Centre (HDC) USA; International Federation of Hospital Engineering(IFHE), UK; the Centre for Health Assets Australasia(CHAA) Australia, and other foreign universities associated as knowledge partners. There will also be emphasis on regional research which it is hoped will lead to efficient and effective healthcare facilities infrastructure development models for rural and metro settings. 

In addition, a Health Engineering Polytechnic has been recommended for each state of India and such polytechnics to be established jointly with medical colleges. These polytechnics will train middle level  hospital technologists ( 1 ½ years training at post-diploma/ advanced diploma level including six-month practical training in hospitals and industries). 

Post-diploma courses in hospital engineering will be awarded with specialisations in:

n Hospital Electrical Engineering Services

n Hospital Planning & Design Services

n Hospital Civil & Public Health Engineering

n Hospital Mechanical Engineering services

n Hospital Information & Computer Services

n Hospital Instrumentation and Control Services

n Hospital Biomedical and Clinical engineering services

n Hospital Chemical/Environmental Engineering Services

There are also advanced modules for technicians ( 6 months) focused on maintenance and repair of hospital buildings, plant, equipment and services, open to qualified graduates in electrical, mechanical, biomedical and other technical trades. 

With the imminent need for qualified technologists to handle the growing development of the healthcare  sector, there is a need for such programmes to be widely available across the country. At present Punjab Engineering College and Chandigarh College of Architecture will offer the programmes, but it is hoped that there will be many more universities and medical schools coming forward to start these programmes. 

Every aspect of a hospital is crucial to the health and safety of the patient whether it is the design, functioning, facilities, or services. An understanding of the multi-dimensional systems at work in a hospital, and a cadre of qualified healthcare technologists to support the infrastructure is one way of achieving it. With ' Health for All'on India's national agenda there is an pressing need to develop heal-tech (healthcare technology) manpower  well qualified  with high order competencies to design, build and maintain the healthcare centres of the future. 

— With inputs provided by Dr JC Mehta, National President, Institute of Hospital Engineering, India  and pioneer of study of Hospital Engineering at PGIMER, Chandigarh


Importance of design and architecture of hospitals

The physical surroundings of a hospital have a direct impact on both staff and patients. The design of a facility/structure with its fixed and moveable components can have a significant impact on human performance, especially on the health and safety of employees, patients, and their families. In several studies conducted, researchers have found that there is a link between the physical environment (i.e. single-bed or multiple-bed patient rooms) and patient (e.g. fewer adverse events and better health care quality) and staff outcomes (e.g. reduced stress and fatigue and increased effectiveness in delivering care). Effective physical surroundings reduce staff stress and fatigue. It also improves patient safety and reduces stress. Findings show that patients too are responsive and expressive about their architectural environment. They appear to make significantly better progress in new properly designed hospital buildings. 

Hospitals are the most complex of building types. Each hospital comprises a wide range of services and functional units. These include diagnostic and treatment functions, such as clinical laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; and the fundamental inpatient care or bed-related function. This diversity is reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialised knowledge and expertise, which is why specialised consultants play an important role in hospital planning and design. 

India lacks in this vital area of expertise. India's healthcare industry with its over stretched and straining healthcare delivery systems is evidence of poor institutional environmental health standards and practices with limited emphasis being given to design and facility infrastructure. Architects designing hospital buildings are rarely knowledgeable about medical architecture, space standards, multiple use of space and environmental considerations. 

Engineers managing hospitals, medical machinery and biomedical equipment do not have the necessary knowledge in relevant subjects. 

There is, thus, a great need for  integration of technical & healthcare education to deliver competencies on these new specialised and merging occupations.

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