INTRODUCTION
“True healthcare facility must not only aid in the physical health needs of its patients, it should
also able to aid the emotional, social, spiritual and environmental health needs of its
patients.”
Philippines is among of the top countries with the highest population rate. Philippines
ranked as the 12th most populous country in the world, contributing 1.35% of the total world
population, based on US Census Bureau. To be more aware, Philippines also belongs to the
third world countries which means that compared to other countries, our country’s
development is slower. There are no enough services and resources to satisfy the increasing
needs of the people, particularly those that lives in the rural and sub-urban areas.
According to the World Health Organization, among the top causes of mortality in the
world are heart and respiratory related diseases. In relation to the statistics of Department of
Health (DOH) of the Philippines in 2016, the said data verified to be true. Heart and lung
According to studies, tobacco usage continues to be the major cause of health problems
worldwide. Currently, there is an estimated 1.3 billion smokers in the world, wherein there are
average 4.9 million recorded deaths in a year because of tobacco usage. If this lifestyle never
stops, it is projected that recorded deaths will elevate to an average of 10 million by year 2020,
Cardiopulmonary Hospital focusing on the spatial needs and effect of colors to the users.
1.3 Assumptions
The study regarding the design of the cardiopulmonary hospital in terms of spaces is
necessary for the development healthcare facilities’ architectural design in the Philippines.
Statistics from Department of Health shows that cardiopulmonary related diseases are the top
causes of mortality in the Philippines. With this study, both public and private health
organizations who are planning to construct a hospital for cardiopulmonary related diseases,
can have a good information on the spatial needs of a cardiopulmonary hospital in terms of
architectural design in the Philippines. This study will be beneficial to individuals and
organizations related in the field of health and architecture. It will help both government and
related healthcare facilities with better and effective architectural design. It will help architects
particularly those specializing in hospital design acquire new information to enhance their
design in the said subject. Lastly, it will help me as an architecture student pass the research
subject and gain confidence in producing such helpful and interesting material.
1.6 Objective
The main objective of this study is to determine the correct design and planning of a
The proponent will analyze the medical condition of some hospitals in Metro Manila to
justify the need of cardiopulmonary specialized hospital in the Philippines. He will also gather
The proponent is expected to make a design solution considering all the information
gathered in this research. The design will only focus on its architectural scope. It will not cover
structural, electrical, mechanical, and other designs that are beyond the control of the
proponent.
• Cardiopulmonary - Of, relating to, or involving both the heart and the lungs. (The
deformities
• Morbidity rate – The proportion of patients with a disease during a given year per
• Mortality rate – also refers to death rate; an expression of the number of deaths in a
population at risk for one year. (Dorland's Medical Dictionary for Health Consumers)
• Specialty Hospital – provides services for one kind of illness/disease or medical care
need.
According to World Health Organizations (2014), 67% of the total deaths in the
Philippines is caused by noncommunicable diseases (NCD), wherein mostly 38% of these are
composed of heart and lung related diseases. Unhealthy lifestyle, particularly tobacco usage,
alcohol drinking, unhealthy diet and lack of physical activity is said to be the major risk factors
(2014).
According to Global Adult Tobacco Survey: Executive Summary (2015), tobacco usage
remains to be the major cause of deaths and diseases worldwide. Almost 6 million people die
every year because of tobacco-related diseases. The number of deaths is expected to increase
to more than 8 million by the year 2030 if the condition left untreated.
The morbidity and mortality rate of cardiovascular-related diseases greatly increases over
the last few years, especially among the low and middle-income countries (LMIC’s), including
the Philippines (Uthman, O.A., et. Al., 2015). Globally, approximately 80% of the total deaths
of cardiovascular-related diseases came from LMIC’s. Factors such as greater tobacco usage
of people in LMIC’s and not having an equal and accessible healthcare services are the major
In the Philippines, the Global Adult Tobacco Survey (2015) shows that 23.8% of total
adults in the country uses tobacco, disregarding the method of usage, wherein 41.9% are men
and 5.8% are women. Generally, regular cigarette smokers consumed an average of 11
cigarette sticks daily, specifically 11.2 in men and 8.6 in women. Generally, the average age
of the regular cigarette smokers between 15-34 years old is 17.5 years old, specifically 17.5
Healthcare industry has a great influence in the development and success of a community
(Aladin, RJL., et.al., 2014). It is the segment that maintains the overall well-being within the
economic system. It provides goods and services that treat patients with curative, preventive,
rehabilitative, and palliative care. Health buildings play a major role than any other buildings
because it has a directly affects human health. With non-stop operation, different types of
activity, and great number of people with different physical and psychological needs, the need
Currently, related professionals, particularly architects, have been studying the effective
designs and spaces that will respond to the needs of patients in terms of both physical and
psychological health (Reginaldo, K.C., 2013). Even cognitive psychologists strongly agree
that physical health environment can significantly affect the physical and psychological
wellbeing of the users (Hughes, 2008). Research collaboration between related professionals
have been striving to find a solution to the increasing need for improvement in the healthcare
setting of hospitals. Healthcare should not only cater the physical health needs of patients but
also psychological health needs through design that encourages social support system between
patient, family, and staff. “Thought in the past to be institutional and restrictive with little
room for creativity, hospitals were likened to machines through the use of adjectives such as
dehumanizing, neutering and frightening” (Vitello, 2011).Most of our current hospitals were
designed in the traditional way, which reported to cause stress, fear and anxiety among patients
Apart from training and work methods, one of the major factors influencing the
productivity of a hospital depends on how spaces and facilities are strategically designed and
layout. The design and layout of a healthcare facility plays an important role in the total
operation of the system. Integration of the user’s needs, materials to be used in terms of
finishes and facility’s operation, and machinery are the vital factors of an effective healthcare
According to Venderber (2015), there are six patterns in the relationships of the built
environment, human health and sustainability that is essential in the healing process of
patients. These six patterns are believed to be valued since the ancient time. These are natural
ventilation, natural daylight and view, water and sanitation, landscape, building configuration
and site planning, conservation of historic resources and local building materials and self-
sufficiency.
The role of design in the healthcare services is not only limited in the aesthetical aspects,
but it should also extend its knowledge in the aspects of human factors, behavior, perception,
emotion and cognition (Health Design Network, 2016). “Building design can help us live
better and longer lives” (Griffin, 2015). Example, a garden that is wisely lighted and located
in the center of the hospital persuade patients and other users to relax for a few moments in
the peaceful garden rather than walking in the busy corridors or sitting in a four-walled lounge
room. In a study by Roger Ulrich’s, he believes that views of nature, such as trees from
There are 5 factors needed to consider in designing a hospital (Abu Al-Ainin, 2013).
These are efficiency, flexibility, interior design aesthetics, cleanliness and easy maintaining,
and accessibility. Efficiency refers to the planning of regularly used spaces through lessening
the travel distance of patients and staff. Flexibility refers to the modular approach in layout
and planning of spaces, and strategically planned open-ended design for future development.
Interior design aesthetics refers to features that helps patients feel comfortable and happy even
in the hospital setting. Example of this is use of lively colors, proper natural and artificial
lighting, beautiful outdoor views and relaxing painting and artworks. Cleanliness and easy
maintaining refers to materials and finishes that are easy to clean, durable, and not easily
stained by dirt and bacteria. Lastly, accessibility refers to universal design in both external and
internal areas of the hospital for the convenience of all types of patients and other users,
Convenience of spaces and sense of security are the factors that contribute major influence
in the satisfaction and well-being of the patients (TNO, 2014). Convenience of spaces is
greater with larger window openings, lesser balustrade and window grills, and more natural
outdoor views. Sense of security is determined on how an unauthorized person can easily
Some current studies also suggest that the natural environment may have a positive
upbringing in relation to human health in three major ways: promoting physical movement,
social relationship, and assisting physical and psychological renewal (Stigsdotter, U.,2015).
There are adequate evidence and leading theories that support the idea such as Affective
providing better services is related to its ability to deal, protect and reduce patient’s stress
influences in worsening patient’s ill condition. The theory is composed of guidelines relevant
in creating an effective environment in healthcare facilities. The data gathered came from
extensive researches from all possible fields relevant to the subject (Laurentz and Rawecka,
2010).
Healthcare facilities should not only be designed to such a place where diseases are being
treated but its overall design should also provide a healthy environment in all aspects of well-
being and aid in the healing process of the patients (Health Building Note, 2014). Themes
whole-life costs and carbon rating, are the necessary design considerations for a sustainable
healthcare facility. To conserve for almost 50% of the regular energy consumption in a
hospital, public or common spaces like lobbies and canteen, it is necessary to optimize the
natural lighting through the use skylights, larger window openings and right selection of the
type of glass (Cabacungan et.al., 2013). A study from Environmental Protection Agency
(2010) shows that switching into a renewable and sustainable energy use can reduce up to 30%
Evidence Based Design (EBD) is a current trend in medical and architectural field in
which the design and planning of healthcare facility is based upon the gathered evidence
through extensive research study (Alfonsi E., et.al, 2014). The primary objective of EBD is to
create an improve health environment integrating the social relationship between the patients,
family and staff. Social relationship is still essential for patients who might be isolated in their
bedrooms (FEMA, n.d.). Hospitals are encouraging family involvement and providing more
public spaces or amenities for social interaction. The introduction of EBD rises from some
common issues that the overall healthcare operation has been encountering. These include
debate between multiple or single bedroom, poor ventilation, noisy and busy surrounding,
unsuitable selection of materials and finishes, absence of social life, and poor staff
There is a significant relationship between color and environment. Color affects our
perception to the type of environment that we are in. Just like in healthcare setting, where
patients were most likely feel unwell, colors can provide healing and comfort on viewers,
Color application in the healthcare design is said to affect patients and other users.
Visually clear signages is essential in guiding patients and other users, particularly those who
are visually impaired and disabled. Approaches like color coding lessens confusion and help
in making decisions. Example of this is red for warning and yellow for caution. Color has a
2004). Textures and selection of materials can assist visually disabled persons through visual
Building Note, 2014). Colors can affect the room lighting which affects the visual comfort of
patients. Use of contrasting colors like white-on-dark color is encourage, while use of
Thought the significant effect of color in the healing process of patients is agreeable, it is
also essential for designers to consider the distinct needs of the different groups of users, such
as the patients, visitors and staff (Ghamari et.al., 2016). In relation to staff, color can decrease
1. Environment
A hospital and other health facilities shall be so located that it is readily accessible to the
community and reasonably free from undue noise, smoke, dust, foul odor, flood, and shall not
2. Occupancy
A building designed for other purpose shall not be converted into a hospital. The location
A hospital and other health facilities shall provide and maintain a safe environment for
patients, personnel and public. The building shall be of such construction so that no hazards
to the life and safety of patients, personnel and public exist. It shall be capable of withstanding
4. Security
A hospital and other health facilities shall ensure the security of person and property within
the facility.
5. Patient Movement
Spaces shall be wide enough for free movement of patients, whether they are on beds,
stretchers, or wheelchairs. Circulation routes for transferring patients from one area to another
6. Ventilation
Adequate ventilation shall be provided to ensure comfort of patients, personnel and public.
7. Material Specification
Floors, walls and ceilings shall be of sturdy materials that shall allow durability, ease of
8. Parking
A hospital and other health facilities shall provide a minimum of one (1) parking space for
9. Zoning
9.1. Outer Zone – areas that are immediately accessible to the public: emergency service,
outpatient service, and administrative service. They shall be located near the entrance
of the hospital.
9.2. Second Zone – areas that receive workload from the outer zone: laboratory,
pharmacy, and radiology. They shall be located near the outer zone.
9.3. Inner Zone – areas that provide nursing care and management of patients: nursing
9.4. Deep Zone – areas that require asepsis to perform the prescribed services: surgical
service, delivery service, nursery, and intensive care. They shall be segregated from
the public areas but accessible to the outer, second and inner zones.
9.5. Service Zone – areas that provide support to hospital activities: dietary service,
housekeeping service, maintenance and motor pool service, andmortuary. They shall
10. Function
The different areas of a hospital shall be functionally related with each other.
10.1. The emergency service shall be located in the ground floor to ensure immediate
10.2. The administrative service, particularly admitting office and business office,
shall be located near the main entrance of the hospital. Offices for hospital
10.3. The surgical service shall be located and arranged to prevent non-related traffic.
The operating room shall be as remote as practicable from the entrance to provide
asepsis. The dressing room shall be located to avoid exposure to dirty areas after
changing to surgical garments. The nurse stations shall be located to permit visual
10.4. The dressing room shall be located to avoid exposure to dirty areas after changing
to surgical garments. The nurse station shall be located to permit visual observation
of patient movement.
10.5. The nursing service shall be segregated from public areas. The nurse station shall
in all inpatient units of the hospital with a ratio of at least one (1) nurse station for
every thirty-five (35) beds. Rooms and wards shall be of sufficient size to allow for
work flow and patient movement. Toilets shall be immediately accessible from rooms
and wards.
10.6. The dietary service shall be away from morgue with at least 25-meter distance.
REFERENCES
http://www.who.int/countries/phl/en/
https://psa.gov.ph/sites/default/files/kmcd/GATS-PHL2016-
Executive%20Summary_13Mar2017.pdf
6. Noël, G., & Frascara, J. (2016). Health and Design: Fostering a culture of collaboration
7. Bosch S. J. (2012). The Application of Color in Healthcare Settings. Jain Malkin, Inc.
11. Health Building Note 00-01. (2014). General design guidance for healthcare buildings.
12. Alfonsi, E., Capolongo, S., & Buffoli, M., (2014). Evidence Based Design and
13. Smith, J. (2007). Health and Nature: The Influence of Nature on Design of The
Environment of Care. The Environmental Standards Council Of The Center For Health
Design.
14. Babin, S. E. (2013). Color Theory: The Effects of Color in Medical Environments.
https://www.fema.gov/media-library-data/20130726-1610-20490-3588/577_ch1.pdf
16. Ghamari, H., & Amor, C. (2016). The Role of Color in Healthcare Environments,
Attribution License.
17. Becker, F., & Parsons, K. S. (2007). Hospital facilities and the role of evidence-based
18. Laurentz, E., & Rawecka, P. (2010). Service Design in Public Healthcare
Handbook for Nurses. Agency for Healthcare Research and Quality (US).
20. Huang, Y. (2011). Impact of Green Building Design on Healthcare Occupants: With
21. Uthman, O. A., Hartley, L., Rees, K., Taylor, F., Ebrahim, S., & Clarke, A. (2015).
22. Cabacungan, N. R., Libiran, D. P. C., & Siobal, A. C. (2013). Design of a Five- Storey
23. Arreola, J. S. (2016). Facility Design for Out Patient Department of Tertiary Public
24. Aladin, R. J. L., Bacay, G. A. D., & Bolo, J. M. C. (2014). Proposed Four-Storey
Medical Center Building using Encased Steel Composite Structure with Green Design
Manila.
26. Mogensen, J., (2013). Health Caring Architecture: Spaces For Social Support. Aalborg
27. Vitello, R. J. (2011). Defining Excellence in Healthcare Design: The Role of Personal
28. Stigsdotter, U. (2015). Nature, Health & Design. International journal of sustainable
30. Castro, M. F., Mateus R., & Bragança, L. (2011). Improving sustainability in
patients, staff and visitors of the hospital will be conducted to accomplish the required data
and information useful in acquiring information about the present condition of the physical
health environment of the hospital, to know the user’s concerns, and to obtain ideas and
recommendations relevant to the research. This research design also aims to understand and
The research instrument to be used will be a satisfaction survey to measure the total
satisfaction rating of the respondents to the physical health environment of St. Luke’s Medical
Center in Cubao, Quezon City. Each respondent was given similar survey-type questionnaire
and they will rate each question based on their personal satisfaction. The satisfaction rate
varies from very dissatisfied, somewhat dissatisfied, neutral, somewhat satisfied and very
satisfied.
The survey will be conducted on St. Luke’s Medical Center (SLMC), Cubao, Quezon
City. SLMC is selected because it is the leading healthcare institution in the Philippines which
provide cutting-edge services on heart and lung-related diseases such as Cardiac Arrhythmia
and Atrial Fibrillation Service, and Congenital Heart Disease Service. They also have
institutes that uses cutting-edge technology for diagnosis and treatment of diseases, such as
(Map)
of the overall services and operation of the hospital and the patient’s physical and
psychological health are mostly affected by the condition of a hospital’s physical environment,
thus their personal preferences is of utmost significant. Staff and visitors will also be the target
of the survey because staff’s work performance and visitor’s comfort are also affected by the
Non-random sampling will be used in selecting the respondents. Among the 100
respondents of the survey, disregarding if they are a patient, staff or visitor, each respondent
will be assigned with corresponding number from 1 to 100. 10 respondents in numbers chosen
between regular intervals of 10 will be selected to represent the whole 100 respondents.
The research design will consist of descriptive and case studies, surveys and data
gathering to determine the current condition of the hospital’s physical health environment
accurately. This research design also aims to understand and determine possible existing
collected from the conducted satisfaction survey. Statistical mode is used to describe the level
of satisfaction with the highest rate. The rate of each level of satisfaction represents the number
of respondents. The higher the rate, the greater number of respondents who agree.
The satisfaction survey aims to understand and analyze the opinions and preferences of
users, namely the patients, staffs and visitors, regarding the physical health environment of St.
Luke’s Medical Center in Cubao, Quezon City. The survey will be answered through a
questionnaire and the target respondents will be the patients, staffs and visitors of the hospital.
CHAPTER IV: ANALYSIS AND PRESENTATION
5
4
3
2
1
0
Comfortable Well-maintained
Good Ventilation Good Lighting
Waiting Area Walls and Floors
Very Satisfied 3 1 2 2
Somewhat Satisfied 5 1.5 1.5 2
Neutral 1.5 1 4 1.5
Somewhat Dissatisfied 0.5 5 2 4
Dissatisfied 0 2 0.5 0.5
Areas in Physical Health Environment
Figure 4: March 2018 - St. Luke’s Medical Center, Cubao, Quezon City Physical Health
Figure 2 shows the total satisfaction rate results of the survey conducted in St. Luke’s
Medical Center, Cubao, Quezon City. In ventilation of the facilities, most respondents (50%)
were somewhat satisfied. In comfort of the waiting area, most respondents (50%) were
somewhat dissatisfied. In terms of lighting of the whole facilities, most respondents (40%)
were neutrally satisfied. Lastly, in maintenance of walls and floor cleanliness, most
(Sample Questionnaire)
NAME :
_____________________________________________________________________
DATE : ________________________________
Please rate the following items based on your level of satisfaction. Please check (√) the box
EE EE
Common Areas
3. Good Lighting
Walls
________________________________
Respondent’s Signature