Biophilic Design (Strategies for hospitals...

Biophilic Design(Strategies for hospitals retrofit)

A Thesis submitted in the Partial Fulfillment for the Requirement of the Degree of Master of Science in Integrated Urbanism and Sustainable Design

by(Sara Mohamed AbdelMeguid)

Biophilic D

esignby (Sara M

ohamed A

bdelMeguid)

(21st July 2014)

Supervised by

Prof. José Luis MoroProfessor of ArchitectureUniversity of Stuttgart

Prof. Dr. . Mohmed A. SalheenProfessor of Integrated Plan-ning and DesignAin Shams University

Dr. Bakr Mohmed GomaaAssistant Professor of Architec-ture and Environmental DesignArab Academy for Science and Technology

(21st July 2014)

Disclaimer

This dissertation is submitted to Ain Shams University, Faculty of Engineering and University of Stuttgart, Faculty of Architecture and Urban Planning for the degree of Integrated Urbanism and Sustainable Design. The work included in this thesis was carried out by the author in the Year 2014

The candidate confirms that the work submitted is his own and that appropriate credit has been given where reference has been made to the work of others.

07/21/2014

(Sara Mohamed AbdelMeguid)

Signature

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acknowledgements

Acknowledgements

It has been a long and bumpy road to finalise my thesis. This would never have been made possible without the support and guidance of so many individuals.

First and foremost, I would like to express my deepest gratitude to my academic supervisors, Dr. Mohamed Salheen and Dr. Jose More. Thank you for your sup-port and insightful comments. To Dr. Bakr Gomaa, I especially thank you for all your efforts, for constantly challenging me and pushing me to my limits. Your support, patience and encouragement provided me with the necessary drive to go the extra mile and complete this thesis.

Beside my academic advisors, I would like to extend my gratitude to the engineer-ing department of 57357 - Children’s Oncology Hospital, Egypt. I thank them not only for their great accomplishments, but also for being a source of inspiration to me and to thousands of individuals and children. 57357 engineering department have been very cooperative whenever approached and to that I am thankful.

I would also like to thank my friends for their help, for their emotional and aca-demic support. A special thanks goes to Mohamed El-Charkawi.

Last, but definitely not least, one cannot forget their backbone, their family. A special and sincere thank you goes to my parents, my sisters, my nieces and to my extremely supportive beloved fiancé. The constant support and encouragement meant a lot to me. Thank you for always having my best interest at heart. Khaled, thank you for always cheering me up and standing by me.

Finally, I want to dedicate this thesis in the memory of Kareem AbdelHaleem. It has been one year since you were gone, but you are always with me in my thoughts. You have surely left a mark.

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abstract

Abstract

This research aims to revitalize the society’s contact and interaction with nature. It is an attempt to close the existing gap that continues to expand nowadays as a result of modernity. Thus, rejuvenating biophilic design that once existed, since this is how buildings were built in the past, is an approach to bridge this gap. Biophilic design is not limited to greening the buildings, but also re-establishing the nature-human being mutual relationship. In other words, the mechanism through which nature is affected by the built environment and conversely how human ambition and experience is affected by nature. Therefore, the domino ef-fect and the correlative relationship between the built environment, nature and human beings, and the extent of effect that each directly has on the other.

Currently, architecture is tending to encourage environmental degradation, over-exploitation, and distancing humans from all natural systems due to modern en-gineers’ empowering humans to disregard genetic and natural heritage. Civilisa-tion is supposed to mend and ameliorate the natural world and not to desolate it.

This research employs the premise of how nature affects human wellbeing and therefore validates and recommends natural attributes to be retrofitted in exist-ing and new health care facilities. These natural attributes are deduced from the design approach that is known as biophilic design. The sequence of the paper ex-plains what the guidelines of biophilic design are through defining each element, illustrating how it impacts human health and further by scrutinizing the strategy of each element. Thereafter, suitable examples that were designed with biophilic design were analysed and compared with reference to the table created with BD guidelines that was used as a guide. Finally, the case study was visited and cer-tain areas was selected to have the model or table checklisted and the presence of the elements assessed and measured in the hospital. The table of guidelines and strategies of BD was initally used as a simple pass or fail criterion and this is the tool that aided in the selection of the area to be analysed. The area of the room was also considered.

Key words: Biophilia, Biophilic Design, wellbeing, nature, strategies, hospitals, architecture

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Table of conTenTs

Table of Contents

List of tabLesList of figures

Chapter 1- introduCtion 1.1- Introduction......................................................................................15 1.2- History of Biophilia..........................................................................16 1.3- Problem Definition...........................................................................17 1.4- Importance of Research...................................................................19 1.5- Aim....................................................................................................19 1.6- Hypothesis........................................................................................20 1.7- Objective...........................................................................................20 1.8- Research Question............................................................................20 1.9- Research Methodology.....................................................................20 1.10- Limitations......................................................................................21

Chapter 2- Literature review: biophiLiC heaLth-Care 2.1- Introduction.....................................................................................23 2.1.1- The importance of incorporating natural elements in health care facilities...........................................................................24 2.1.2- Emphasizing the concept of OHE..........................................25 2.1.3- History of OHE.......................................................................25 2.1.4- OHE in depth..........................................................................25 2.1.5- Theory of Supportive Design..................................................26 2.2- Indoor Environmental Quality.........................................................27 2.2.1- Daylight...................................................................................27 2.2.1.1- Attention Restoration Theory...................................28 2.2.1.2- Impact of natural daylight on human health............29 2.2.1.3- Factors for determining the size of a window...........30 2.2.1.4- Light Shelves.............................................................30 2.2.1.5- Top Lighting...............................................................31 2.2.1.6- Shading Devices........................................................32 2.2.1.7- Daylight Factor..........................................................33

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StrategieS for hoSpitalS retrofit

2.2.1.8-Egypt Requirement for Shading Devices..................34 2.2.2- Natural Ventilation.................................................................36 2.2.2.1- Driving Forces of Natural Ventilation......................36 a- Wind Driven.........................................................36 b- Bouyancy Driven..................................................36 2.2.2.2- Strategies of Natural Ventilation.............................37 a. Single-Sided Ventilation.......................................37 b- Cross-Ventilation.................................................38 c- Stack Ventilation..................................................39 2.2.2.3- Natural Ventilation Quantification..........................40 a- Airflow Rate..........................................................40 b- Ventilation Rate...................................................40 2.2.3- Views.......................................................................................41 2.3- Biodiversity and Landscape...............................................................42 2.3.1- Biodiversity.............................................................................42 2.3.2- Landscape...............................................................................43 2.4- Water.................................................................................................44 2.4.1- Water Features........................................................................44 2.4.2- Water in Motion......................................................................45 2.5- Built Form.........................................................................................45 2.6- A Framework for Biophilic Design...................................................47

Chapter 3- anaLytiCaL study 3.1- Introduction and Study Scope.............................................................53 3.2- Khoo Tech Puat Hospital, Yishun, Singapore.......................................54 3.2.1- General Description of Project...............................................54 3.2.2- Urban Context........................................................................55 3.2.3- KTPH: Biophilic Design Elements Analysis...........................57 3.2.3.1- Natural Daylight........................................................57 3.2.3.2- Natural Ventilation...................................................59 3.2.3.3- View..........................................................................60 3.2.3.4- Biodiversity and Landscape......................................61 3.2.3.5- Water.........................................................................62 3.2.3.6-Built Form..................................................................62 3.3- KTPH: Discussion..............................................................................66 3.4- Palomar Medical Center West, Escondido, California..........................67 3.4.1- General Description of Project...............................................67

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Table of conTenTs

3.4.2- Urban Context........................................................................68 3.4.3- PMC: Biophilic Design Elements Analysis.............................70 3.4.3.1- Natural Daylight........................................................70 3.4.3.2- Natural Ventilation...................................................71 3.4.3.3- View..........................................................................72 3.4.3.4- Biodiversity and Landscape......................................73 3.4.3.5-Built Form..................................................................73 3.5- PMC: Discussion................................................................................77

Chapter 4- Case study 4.1- Introduction and Scope.....................................................................79 4.2- 57357: Children Oncology Hospital, Cairo, Egypt............................79 4.2.1- General Description of Project...................... ........................80 4.2.2- Urban Context........................................................................81 4.3- Chemotherapy Ward.........................................................................82 4.3.1- Questionnaire..........................................................................83 4.3.1.1-Methodology...............................................................83 4.3.1.2-Results.........................................................................85 4.3.2- 57357: Biophilic Design Elements Analysis...........................87 4.3.2.1-Natural Daylight..........................................................87 4.3.2.2-Natural Ventilation.....................................................88 4.3.2.3-Views...........................................................................88 4.4- Inpatient rooms.................................................................................91 4.4.1- 57357: Biophilic Design Elements Analysis...........................92 4.4.1.1-Natural Daylight...........................................................92 4.4.1.2-Natural Ventilation.....................................................93 4.4.1.3-Views...........................................................................93

Chapter 5- ConCLusion and reCommendation...................97

referenCes

appendix a- Questionnaire for Chemotherapy wardappendix b- tabLe of average daiLy wind speed in singaporeappendix C- graph for average monthLy wind speed in esCondido

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list of tables

List of Tables Table 2.1 - Types of shading devices.....................................................................32Table 2.2 - Framework of Biophilic design guidelines........................................48Table 3.1 - Results of KTPH inpatient wards assessment....................................64Table 3.2 - Results of PMC inpatient room assessment.......................................75Table 4.1 - Results of 57357 chemotherapy ward assessment.............................89Table 4.2 - Results of 57357 inpatient rooms assessment...................................94

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list of figures

List of Figures Figure 1.1 - Picture of Al-Miri Governmental Hospital, Alexandria....................18Figure 1.2 - Methodology of Research..................................................................21Figure 2.1 - A framework portraying developments made in an optimal healing environment......................................................................................26Figure 2.2 - Diagram explaing the factors affecting well-being of patients adapt ed from Huelat,2008 explanation....................................................27Figure 2.3 - Effects of light shelf position on the illuminance level....................30Figure 2.4 - Different types of toplighting...........................................................31Figure 2.5 - Different types of horizontal overhangs ..........................................33Figure 2.6 - Angle of visible sky.......................................................................... 34Figure 2.7 - Building orientation for hot-arid climates...................................... 35Figure 2.8 - Single-sided ventilation air flow .....................................................37 Figure 2.9 - Wind driven single-sided ventilation...............................................37Figure 2.10 - Wingwalls........................................................................................38Figure 2.11 - Cross ventilation air flow................................................................38Figure 2.12 - Wind-driven cross ventilation .......................................................38Figure 2.13 - Flow of cross ventilation.................................................................39Figure 2.14 - Opposite effects of wind and stack..................................................39Figure 2.15 - Stack effect- various ways for cooling upper level..........................39Figure 3.1 - KTPH perspective across Yishun pond............................................ 54Figure 3.2 - KTPH site plan..................................................................................55Figure 3.3 - KTPH zoning......................................................................................55Figure 3.4 - KTPH circulation path......................................................................55Figure 3.5 - KTPH floor plan of naturally ventilated wards.................................55 Figure 3.6 - KTPH floor plan of air-conditioned wards.......................................56 Figure 3.7 - Simplified architectural plan of the 4-bed air-conditioned ward....57Figure 3.8 - Simplified architectural plan of NV ward ........................................57 Figure 3.9 - Typical cross section of both wards..................................................57Figure 3.10 - External perspective of the ward....................................................58Figure 3.11 - Colour gradient to show the decrease in illuminance level in ACW.................................................................................................58Figure 3.12 - Colour gradient to show the decrease in illuminance level in NVW...............................................................................................58Figure 3.13 - Cross section showing effects of different positions of light

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shelves..............................................................................................59Figure 3.14 - Cross section showing light bouncing on light shelves .................59Figure 3.15 - Elevation of the private wards with non-operable windows .........60Figure 3.16 - Elevation of subsidised wards showing the operable windows ....60Figure 3.17 - 3D section of the naturally ventilated subsidised ward ................60Figure 3.18 - View to the Yishun pond from inpatient rooms............................ 60Figure 3.19 - View of the court............................................................................. 61Figure 3.20 - Planter boxes outside patient rooms and between corridors .......61Figure 3.21 - KTPH rooftop gardens ...................................................................62Figure 3.22 - KTPH meditation garden.............................................................. 62 Figure 3.23 - Water features in the site ..............................................................62 Figure 3.24 - Interior of a naturally ventilated ward..........................................62 Figure 3.25 - Interior of a private air-conditioned ward.................................... 63Figure 3.26 - Plan illustrating the difference in both wards.............................. 63 Figure 3.27 - Perspectie of PMC..........................................................................67 Figure 3.28 - PMC: site plan................................................................................68 Figure 3.29 - PMC: typical architecture floor plan..............................................69 Figure 3.30 - Dimensions of inpatient room.......................................................70Figure 3.31 - PMC: inpatient room strip section................................................70 Figure 3.32 - Interior of inpatient room.............................................................70 Figure 3.33 - Daylight illuminance gradient plan................................................71Figure 3.34 - Cross section to show the decrease of daylight in the room...........71Figure 3.35 - Zoning perspective..........................................................................72Figure 3.36 - Wavy green roof floor plan.............................................................73Figure 3.37 - PMC skylight in the wavy green roof..............................................73Figure 3.38 - Accessible terraces..........................................................................73 Figure 3.39 - Perspective of PMC inpatient rooms..............................................74Figure 3.40 - Descriptive plan of PMC inpatient rooms......................................74Figure 4.1 - Perspective of 57357 hospital...........................................................80 Figure 4.2 - 57357: Urban context........................................................................81 Figure 4.3 - 57357: First floor plan......................................................................82Figure 4.4 - 57357: Plan of chemotherapy ward..................................................82Figure 4.5 - 57357: Panoramic view of chemotherapy ward...............................82Figure 4.6 - 57357: Plan of chemotherapy ward with daylight gradient............88Figure 4.7 - View from CTW.................................................................................91Figure 4.8 - Typical plan of inpatient room.........................................................91Figure 4.9 - Strip section of room 2 showing the opposite building...................92

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list of figures

Figure 4.10 - Daylight gradient in room 1 and room 2........................................92Figure 4.11 - View from room 1............................................................................93Figure 4.12 - View from room 2...........................................................................93

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introduction

Chapter 11.1 Introduction

The only way to make truly sustainable architecture is to connect our buildings to nature - not insulate them from it -Rachel Armstrong

Health is one of the fundamental rights that every human being should be entitled to. It is a universal right that States must commit to protect (The Right to Health , Factsheet 31, p.1, OHCHR and WHO, undated.). The Right to Health is encom-passed in numerous conventions and legislations that highlight its importance. The output of such policies is ideally improving and increasing health facilities and professionals in the healthcare sector. However, realistically, even though an increase does in fact take place in most countries, the quality of healthcare in general is in constant deterioration in many countries especially in developing and underdeveloped ones. Thus health is worsening which also reflect the eco-nomic status of a State. According to statistics and studies carried out by World Health Organisations (WHO) and other organisations, healthcare - symbolised in the mortality rate – has proven in many ways to be related to the income rate (class) and the development of a country. Therefore, health is a political, social and economic matter that must be tackled.

Several undeveloped countries, regardless to the existence of various resources such as man power (professionals in the field), land, etc, have shown poor health-

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care access to those with low-income. Moreover, the health facilities are usually constructed of minimum standards. This research aims to target such countries in need of optimizing healthcare access of patients, decreasing sufferings and mortality rate regardless of the income rate. So, the research will introduce sus-tainable methods and suitable techniques that would include natural elements to ensure maximum healthcare within a specific economic context, thus attempting to fulfil one of the fundamental human rights.

In order to allow for sustainability to limit patient suffering and develop their healing process, it could be achieved not solely by improving the medical tech-niques, but by refining the setting and build-up of facilities. Consequently, the re-search tackles incorporating natural elements and nature logic within the archi-tecture of medical facilities to serve patients and those in need. This stems from the make-up and rationale behind nature and all its finest details that primarily target humans’ wellbeing. Thus, employing such elements in healthcare facilities should alleviate patient suffering and progress.

1.2 history of biophilia

Erich Fromm, a German psychologist repeatedly used the word ‘Biophilia’ as a characterization of a psychological orientation. Edward O. Wilson described Bi-ophilia in his book ‘ Biophilia’ as ‘the innate tendency to focus on life and lifelike processes’(Wilson, 1984, p.1). He describes his provocative concept of biophilia through a series of anecdotes and examples from the creatural world. The book explains the case that humans, having evolved in the midst of a natural realm re-plete with species diversity, need that environment for their basic well-being. He projected the prospect that the human beings are innately attached or connected with nature. Edward O .Wilson pioneered the fact that there is an instinctive bond between human beings and other living systems.

Biophilic design is a design approach that came into sight and developed decades ago and reciprocated E. Wilsons’ demonstrations in his book Biophilia. Simply, biophilia means ‘love of life’(Miller, 2013). Wilson and Stephen Kellert, a Yale professor, have long-drawn-out and elaborated on the idea to incorporate basic human needs that grew through and became fulfilled by their correlation with the natural world (Miller, 2013).

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introduction

1.3 Problem Definition

As previously mentioned, Biophilic design is the deliberate attempt to translate an understanding of the inherent human affinity to affiliate with natural systems and processes into the design of the built environment.

Architects must consider the positive or negative influence of hospital designs on patients as architecture is the art which provides or stimulates human health and well-being. It is the integration between the built environment, natural environ-ment and human beings. Yet, the voice of nature must be heard by architects and planners to avoid tedious scenes. The responsibility of architects goes beyond the functionality of the building or the selection of materials or methods. Rather, the buildings that they shape and design strongly influences the emotional and health status of the users (Baird, 2010, p.1).

Thus, a relationship should be initiated between human beings and the envi-ronment of the building. An understanding to the definition of ‘nature’ should be reviewed, and more importantly, revisiting the current understanding of the importance of the presence of nature or natural elements. This would be tackled through a selected case study, which is Egypt, to identify the problems that arise in a developing country, with a wide population sector that fall under low-income rates and have limited and poor healthcare access.

The following are photographs from ‘Al-Miri Governmental Hospital’ which is a public hospital in Alexandria, Egypt are taken to resemble an example of health-care facilities and their status:

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As portrayed above, pictures taken of the hospital reflect the poor state that hos-pitals are in in Egypt. Health establishments in Egypt are intensely increasing and expanding in the same quality and manner. The increase is as a result of the increase in demand of healthcare. However, more flaws are surfacing. It has be-come the norm in Egypt to convert buildings which are incompatible with proper hospital structures and needs into hospitals. Additionally, if a hospital is being constructed it fails to abide by the minimum standards of a patient oriented hos-pital, and having limited relation to nature and natural elements. The buildings, facilities, and hygiene in hospitals are atrocious. Thus, the purpose behind this paper is to analyse and examine the current use of natural elements in health establishments in Egypt and anticipate improvements in order to better serve users.

This paper will use psychological theories related to architecture, which states that the existence of nature and landscapes can transform a tiresome space into a much more encouraging space to its users or viewers such as Ulrich’s ‘‘Stress Re-covery Theory’’ claims (Ulrich,1984, 1999). He states that natural scenes tend to reduce stress, whereas settings in the built environment tend to hinder recovery from stress. Having the functionality taking the lead resulted in an outcome of stressful, displeasing hospitals located internationally that are also unsupportive of the patients’, visitors and staffs emotional needs (Ulrich, 2002).

(fig. 1.1)—Pictures of Al-Miri Governmental Hospital in Alexandria, EgyptSource: (hazemhassanin25, 2011)

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introduction

(fig. 1.1)—Pictures of Al-Miri Governmental Hospital in Alexandria, EgyptSource: (hazemhassanin25, 2011)

1.4 Importancce of Research

As mentioned earlier the right of health is a fundamental right that each human being, regardless of their race, socio-economic class, religion or nationality is en-titled to have. Therefore, the main purpose of the paper is to reinstate this right and help those in need.

In hand with the right of health, the usage of efficient and optimal techniques inspired by nature is the method of usage in this research. This research empha-sises on creating sustainable facilities that focuses on natural elements is to best serve users. This is because nature and natural elements usage in the everyday life, especially in recovery processes continue to prove its success and sustaina-bility. Nature is created to serve mankind in great quality. Consequently, such quality needs to be set in motion.

Therefore, this research aims to initiate an improvement in medical facilities that are sustainable and affordable to users. Such changes would serve patients in hospitals while using biophilic designs to reinstall the importance of the human beings in the context of hospitals moving away from the exclusively, business oriented health facilities.

Such research will be applied on Egypt as a case study. Egypt is a developing country with a large population sector with low-income, and thus with very poor healthcare of patients. The poor healthcare is drastically affecting patients’ re-covery process due to the lack or absence of certain strategies or elements in the design. Furthermore, Egypt has various resources that are misused and numer-ous natural elements that can be utilized more efficiently to serve the increasing population and the deteriorating healthcare.

1.5 Research Aim

This research aims at supporting, designing and building sustainable healthcare facilities with high standard specifications through incorporating nature in the build-up of medical facilities in order to alleviate patient suffering and improve healthcare through the notion of ‘Biophilia’. This will support and guide archi-tects to consider vital elements in their design such as, meeting the psychological needs of patients and specifically long-term patients.

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1.6 hypothesis

This research assumes that the utilisation of Biophilic design elements and at-tributes improves the efficience of health care facilities and improves human psy-chological status and wellbeing.

1.7 Objective

The objective of this thesis is to further promote the development of hospitals in Egypt through retrofitting hospitals with biophilic design elements. Accordingly, this paper will exhibit the influence of architectural designs on patients. It will also discuss the fact that nature oriented architectural designs does positively influence the health and psychological status of patients.

• Identify the most relevant biophilic healthcare design that are of relevance to the Egyptian context.

• Clear understanding to the point of retrofit• Deduce a model of biophilic design principles for health cares• Reveal the shortcoming of present design practices of healthcare facilities• Conduct the design principles against the local case study to calibrate the

model for the Egyptian context

1.8 Research question

What are the design guidelines that can be deduced from biophilic concepts to retrofit in Egypt?

1.9 Methodology of Research

• An efficient literature search and data collection on the topic of biophilic de-sign

• Careful examination of the literature and theories of biophilic design in order to define its guidelines

• An overview and careful clarification on the subject of retrofit• Analytical study of health-care facilities that used biophilic design in order to

endorse or approve the guidelines • Recognise and select a health-care facility in Egypt that is of relevance to the

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introduction

topic• Use the guidelines of biophilic design to assess the presence of the elements

or its applicability in the selected case study

1.10 Limitations

The research process and application was affected due to several factors that in-cluded:

• The administration of ‘57357’ hospital prohibited access to patients, thus, the hospital staff – nurses, engineers and doctors – filled the surveys;

• The research was limited as a result of the small sample size. The sample size could have been both more comprehensive and expanded by having the patients involved;

• Most of the patients were uneducated, from a low social and financial class, eventhough their opinions on shaping the environment in which they are in would be of significant value;

• Absence of interviews with patients and visitors in the methodology;• Time constraints, where the period in which the research was conducted, six

months, was very limited.

Literature Review

On the topic of Bio-

philic design (BD)

Select examples of

healthcare facilities

that used BD

A Framework or a

model with a summa-

ry of BD guidelinesHistory of Biophilic

design (BD) Use the model to

assess the hospitalElements & attributes

of BD Approve the guide-

linesHow every element

impacts human

health

Strategies of elements

Framework/Model Examples Analysis

Case study selection

Case study assessment

(fig. 1.2)—Methodology of researchSource: Author

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elements of biophilic design

Chapter 2Elements of Biophilic Design

2.1 Introduction

“We should bring as much of nature as we can into our everyday environments so as to experience it first-hand; second, we need to

shape our built environment to incorporate those same geometrical qualities found in nature” (Kellert, Heerwagen and Mador, 2008)

When introducing biophilic designs, the above mentioned statement encompass-es the essence of what it represents; Biophilic designs is the deliberate attempt to translate an understanding of the inborn affinity of human beings to natural sys-tems and processes to be incorporated into the design of the built environment (Kellert, Heerwagen and Mador, 2008).

The importance of biophilic design stems out of the ongoing global deterioration as a result of technological hegemony. As much as technological advancements have positively affected one’s life, it also, nevertheless, continues to have severe negative and destructive impacts not only architecture but also on the society and the world (Molthrop, 2011). Looking at the history of architecture, it is noticed

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that a prevailing trend reflects a change in the prioritization of buildings moving away from the touch with nature from being user-oriented towards a more aes-thetic perspective (Kellert, Heerwagen and Mador, 2008).

Therefore, biophilic design emerged as an outcome of such aesthetic-oriented buildings. It restricts building design to the interference of natural elements in order to primarily maximize human functioning and health. It focuses on one goal, which is creating a natural-based environment for humans (Molthrop, 2011). The concept of biophilic designs is an attempt to reclaim the fundamental purpose of buildings, which is to serves the user rather than for visual decor.

2.1.1 The importance of incorporating natural elements in healthcare facilities

When questioned on how natural-based elements would contribute to the opti-mal positive impact on humans, the response is simple, according to scientific findings, nature acts and works upon healing. Healing refers to mental, psycho-logical, emotional and physical healing.

This thus is further analysed to elaborate on the importance of biophilic design in building healthcare facilities. According to some research conducted, when human beings are in contact with nature it would contribute in: lowering blood pressure, a positive emotional state, lowering the levels of stress hormones, boosting energy, minimizes the effects of disease and it is also presumed that cancer patients tremendously favour from such contact (Huelat, 2008).

According to (Ornstein and Sobel, 1990), “Flooding our brains with rich nat-ural visual stimulation helps us recover from surgery, tolerate pain, manage stress, and attain wellbeing.” ‘Natural visual stimulation’ would refer to natural elements such as of ponds, streams, trees and other vegetation (Huelat, 2008). Such elements have positive impacts on patients and human beings in general.

Therefore, when planning a healthcare facility, certain solid values must be de-rived from the natural world, where sustainable green design would be an im-portant factor in such designs; “A growing body of research suggests that this human affinity to nature—plants, animals, and landscapes—is something hard-wired into us. Scientists call it ‘biophilia’ ” (Huelat, 2008).

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Eventhough the significance of biophilic design has been long proven yet, health care facilities in Egypt do not respect proper functionning and structure nor obey basic design rules. Private hospitals are divergent to public hospital yet, most of them are also not provided with such basic design elements and attributes such as daylight, natural ventilation, views etc. Patients are accomodated in large air conditionned rooms with proper treatment in return to the bulk amount of mon-ey being paid to the hospital.

2.1.2 Emphasizing the concept of ‘Optimal Healing Environment’

The statement ‘Optimal Healing Environment’ (OHE) is one that was developed scientifically with a target to aid the transformation of how healthcare is deliv-ered (Samueli Institute, 2011).

2.1.3 history of ohe

The roots of OHE dates back to ancient Greece, where the notion of a ‘healing space’ was a cornerstone in their daily and spiritual lives. The temple of Epi-daurus was a sanctuary built for the ‘God of Asclepius where ill people went in the hope of having dreams where he would reveal the cures for ailments’.In around 1860, ventilation and fresh air were praised by Florence Nightingale as the first rule of nursing in addition to eliminating ‘unnecessary noise, and providing proper lighting, warmth, and clean water (Samueli Institute, 2011).

Healing space is composed with the availability of: access to nature, good air quality, pleasant or positive distractions, and reduction of environmental stress-ors such as unnecessary noise, and toxic or harmful substances, aroma, music and colour (Samueli Institute, 2011).

2.1.4 OHE in depth

OHE is in constant development to be tailored to fit the ever-changing environ-ment. The following table briefly portrays recent developments in the OHE show-ing the integrated system of how every factor is affected and affects every other factor.

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When analyzing such effects of natural elements on the notion of health care, we also need to take into consideration the different factors affecting the health care environment. The health care environment, and by default the patient, is affected by a combination of economic, social, cultural, psychological and environmen-tal factors (Huelat, 2008).Scientific investigations carried out have shown that an OHE is one where all factors and components, whether social, psychological, physical, spiritual and behavioural (refer to figure 2.2), bond together to sup-port the human wellbeing and stimulates the body’s ability to heal itself (Moore, 1979). Roger Ulrich introduces the theory of supportive design as an initial point to denote stress.

2.1.5 Theory of supportive design

According to (S. Ulrich, n.d., pp. 97-109) The theory of supportive designs’ main principle underlines that in order to foster human health and well-being, health-care environments should aid and stimulate coping stress through their design. These health-cares should not raise hindrances to cope with stress as this will therefore add to the burden of illness. The design of these facilities should incor-porate both access and exposure to physical features as well as social states since they sometimes have impacts on dropping stress level. Additionally, the groups targeted in healthcare facilities should encompass all patients, visitors and staff.

The theory revolves around the notion or perception of stress and to intellectual-ize or theorise the impact of human beings in the design. This can further develop

(fig. 2.1)—A framework portraying developments made in the optimal healing environmentSource: Samueli Institute, 2011

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(fig. 2.1)—A framework portraying developments made in the optimal healing environmentSource: Samueli Institute, 2011

this theory in measures of wellness that are scientifi-cally reliable. Heathcare facilities should be designed to nurture physical surroundings that embody ele-ments that are considered positive distractions, ad-mittance to social care and support and, controlled physical-social surroundings. Different scientific studies shaped the criteria of the theory of supportive design and proved that it influences wellbeing.

Consequently, this chapter will point out BD ele-ments and attrubites. First, a clear definition of every element and how it impacts human health will be il-lustrated followed by stating the rules and strategies of each element. Finally, A table or framework will be created as an extract or a review of the BD guidelines.

2.2 Indoor Environmental Quality (IEQ)

According to (Massawe and Vasut, 2013), health care inhabitants are sorely affected by the quality of the indoor environment. Healing environments require satisfactory and superior indoor environmental qual-ity. However, in some cases, the levels of indoor air impurities may exceed the outdoor pollutants leading to poorer indoor air quality than that of the outdoor.

There are several factors affecting the indoor air qual-ity which accordingly affects the psychological com-fort of patients. These factors are natural daylight, natural ventilation and views (Massawe and Vasut, 2013).

2.2.1 daylight

The high dependency of artificial lighting in the built environment isolates the users from the surrounding and hence from the natural elements and process-

(fig.2.2)- Diagram explaining factors affec-ting well-being of patients adapted from Huelat, 2008 explanationSource: Author

28


es that they are innately in need of. The reliance on natural daylight stretches ahead than only excluding or substituting artificial lighting to save energy in a building nor to only light the building internally. Throughout history, the hu-man dependency on sun for wellbeing has been acknowledged (Huelat, 2008). Moreover, this assures that sunlight is one of nature’s decisive elements affect-ing human health (Kellert, Heerwagen and Mador, 2008). The daylight enters a room through a window which transmits the view of the outdoor setting. In other words, it strongly connects the indoor environment with the outdoor environ-ment (Daylighting in Low Energy Buildings, 2010). Human beings are inherently automated to positively respond to well-lighted areas over dark ones (Molthrop, 2011). To sum up, the human body is entirely affected by the sun from the mo-ment the eye catches it (Huelat, 2008).

Daylight is characterized into direct and diffuse components. The direct light re-fers to the light reaching the earth from the sun. Diffuse light refers to the sky-light or in other words, the scattered part of the sunlight through the atmosphere (Daylighting in Low Energy Buildings, 2010). When considering the usage of nat-ural daylight in a building, its two components, sunlight and skylight should be considered. Sunlight should only be disregarded under the condition of causing thermal or visual discomfort which may be caused when light is in excess due to it not being in control by a well-designed opening (Daylighting in Low Energy Buildings, 2010). The amount of daylight entering through a window is directly proportional with the size of the window. Windows used for the penetration of daylight use glass with higher Variable Light Transmission (VLT) to allow the penetration of light at a great depth in the space (REEEP, 2010).

The dependence on light increases with the increase of age and is also linked with better performance of complex visual tasks and with increased satisfaction with the work environment. Errors could occur in environments that are accompanied with inadequate lighting due to the stress it causes the staff (Joseph, 2006).

2.2.1.1 Attention Restoration Theory

Attention restoration theory (ART), a theory developed by Stephen Kaplan, as-serts that when human beings invest their time in nature or only observe scenes of nature, they subsequently have a more focused attention. Directed-attention abilities gain strength and are improved by means of natural environments. For-

29


mer researches have indicated that ART break off into involuntary attention and voluntary attention (Berman and Jonides et al., 2008, pp. 1207-1212).

There are multiple psychological benefits of introducing natural daylight into a building (Cornwell, 2013). “Daylight has been scientifically proven to improve academic performance, increase productivity, reduce absenteeism and contrib-ute to general wellbeing” (Cornwell, 2013). In other words, “The decreased ex-posure to sunlight causes a high incident of irritability, fatigue, illness, insomnia, depression, alcoholism, and suicide” (Huelat, 2008).

2.2.1.2 Impact of natural daylight on human health (Joseph, 2006) (Day-lighting in Low Energy Buildings, 2010),

• Easing the performance of visual tasks• Controlling the body’s circadian system• Affecting mood and behaviour• Facilitating direct absorption for critical chemical reactions within the body• Production of vitamin D in the body• Stimulation of an antidepressant called ‘serotonin’ naturally found in the hu-

man body• Supressing a sleep inducer called ‘melatonin’ naturally found in the human

body

Patients’ wellbeing and physiological status should be directly linked with the daylight accessibility in their rooms (Joarder and Price, 2013). As previously mentioned, the human body highly depends on the exposure to natural daylight for the production of vitamin D in the body (Joseph, 2006). However, according to (Daylighting in Low Energy Buildings, 2010) the UV-B light in charge of this process is blocked with the presence of glazing. This is why outdoor activities play a vital role for human beings. Additionally, an antidepressant called ‘serotonin’ that is naturally found in the human body is stimulated as a result of exposure to daylight. Besides, a sleep inducer called ‘melatonin’ which is also naturally found in the human body is suppressed as a result of exposure to light.

“Sufficient daylight is generally only available up to a distance of twice the height of the window head height (measured from the ground and in the direction parallel to the window) above the working plane into a room’’

30


(Daylighting in Low Energy Buildings, 2010, pp.21).

However, the illuminance of daylight near the win-dow is significantly different than that at the opposite wall (Joarder and Price, 2013).

The ideal determination of the window size and the ideal usage of lighting controls will result in modulat-ing daylight admittance and dodge the usage of elec-tric lighting (REEEP, 2010).

2.2.1.3 Factors for determining the size of a win-dow (Daylighting in Low Energy Buildings, 2010)

• The amount of daylight provided• The distribution of daylight• The interaction with other design requirements, for example heat loss/gain or ventilation.

Since windows or glazing areas play an important role in transmitting daylight in a room, the glazing area should be more than 8 % of the room area and less than 20 % of the room area. However, exceeding this range can be accepted depending on the context and weather description.

Advance techniques and devices are available to con-trol the amount of light entering a room. This control could either be to increase or decrease the quantity of light entering. These devices are light shelves, top-lighting and shading devices.

2.2.1.4 Light shelves

Light shelves are used to enhance the quality and amount of daylight in the room (Daylighting in Low

(Fig.2.3)- Effects of light shelf position on the illuminance levelSource: (D-lite.org, n.d.)

31


Energy Buildings, 2010). Light shelves are factually overhangs that reflect light and could either be positioned in the interior or exterior of the room or both. They shade the space from direct sunlight which is then reflected onto the ceiling for deeper penetration of the light into the room and hence, provide more uni-form distribution (CIEE, 1997).

Criteria for light shelf design (CIEE, 1997);

• Light shelves are not suggested for desert climates as they are characterised to have acute solar heat gain.

• They are recommended to be fixed on the orientation of the building where the greatest amount of sunlight is found.

• Its material should be of high reflectivity in order to preserve the maximum quantity of light

• Glazing areas that are greater than 2.2 meters is where the light shelves are most useful.

Application of light shelves (CIEE, 1997)

• Light shelves result in breaking up the window to a ratio of 1/3:2/3• They are to be located above head height H > 2.2 m • Light finish is required to maximise the reflection of daylight• Thumb rules indicate that the shelf width is to be 1.25-1.5 times the height

of the clerestory when located in the south side of the buildings and 1.5-2.0 when located in the east or west side.

2.2.1.5 Top-lighting

Spaces lit by top-lighting are provided by significantly different lighting from spaces lit by windows. They provide light that is distributed uniformly through-out a space (Envelope and Space Planning, 1999).

(Fig.2.4)- Different types of top-lightingSource: Envelope and space planning, 1999

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2.2.1.6 Shading Devices

Shading devices could be added internally or externally in different orientations to control the excess solar radiation entering the window. Glare is curtailed by the use of shading devices as the intensity is adjusted besides resulting in proper dis-tribution of daylighting entering the room. With regard to direct sunlight which affects the user from the comfort facet, this is controlled by the use of shading devices which guarantees the user a more comfortable environment. However, direct sunlight is passable in public spaces such as, lobbies or circulation regions. Moreover, its presence is necessary as a visual connection and emotional relation to the external environment is offered (CIEE, 1997).

Fragmented horizontal and vertical overhang

When the height of the window is maxed out, it results in having a great width of the horizontal or vertical projection. In this case, fragmenting the given width

Types of shading devices Interior Exterior

They are capable of controlling solar gain but, all methods of interior shad-ing devices are less effective than those of the exterior shading devices because they allow the entrance of the sun’s heat and additionally because they lim-it a view to the external environment.

Light coloured louvers or blinds are to be used with the purpose of reflecting out the sunlight.

These devices are either anchored to the skin of the building externally or an extension of the external skin to block undesirable solar heat. Exterior shad-ing devices are to a greater extent more efficient than interior shading devices in obstructing unwanted solar heat.

• Horizontal overhang or Fragment-ed horizontal overhang

• Horizontal overhang with screen-ing

• Vertical fins or Fragmented verti-cal fins

Table 2.1- Types of shading devicesSource: Author (adapted from CIEE, 1997)

33


into several equivalent smaller parts at equivalent depth can be an ideal solution. (CIEE, 1997). The equation to determine the size of vertical fins and horizontal overhangs (Goma’a,2014); where x is the azimuth angle Tan 90-x = W/H (2.1)

Equation to determine the size of horizontal overhang with screening (Go-ma’a,2014);

Tan 90-x = W/H2-H1 (2.2)

Azimuth angle

The azimuth angle is the horizontal distance at which the sun is seen over the horizon by the observer. It depends on the location (longitude) and time of the day. It literally illustrates the location of the sun over the horizon(CIEE, 1997).

2.2.1.7 Daylight factor (DF)

The criteria for designing buildings or parts of buidings in order to provide the necessary daylight is expressed and presented in terms of DF for evaluation. Day-light factor points out the percentage of visual requisiteness or competence of daylighting in an entire space and not just at a specific point (Li, Lam and Wu, 2014).

(Fig. 2.5 ) Horizontal overhang, fragmented horizontal overhang, horizontal overhang with screening and different effects of louvers and overgangSource: CIEE,1997

34


Criteria of daylight factor ; (Goma’a,2014)

DF = (2.3)

• Aglazing = Glazing area or window area• = Sky angle or angle of visible sky • Atotal = Total area of all interior surfaces including

windows• R = Surface reflectance of interior surfaces ( a val-

ue of 0.8 is used)

The optimal daylight factor varies from space to space depending on its function. In general the average op-timal range is between 2 % - 5 % where rooms below 2% are to be considered insufficiently lit. According to (Consultations.rics.org, 2014), the criteria of daylight factor in inpatient rooms is 3 %. Rooms that have a DF that is below this value, is considered to be dimly lit unless light shelves are present.

2.2.1.8 Requirements for Shading Devices in egypt

Egypt is considered to have a hot-arid climate. Ac-cording to (Givoni, 1998) hot-arid climates have sig-nificantly direct and reflected radiation than all other types of climate. The north orientations are relished with slightest radiation allowing the application or positioning of sizeable windows for adequate day-lighting. In south orientations, the sun is at a very high angle in the summer and is therefore easy to shade. Nevertheless, it is at a low angle in the win-ter allowing solar penetration and therefore requires

Sky angle is the vertical angle in degrees subtended at the centre of the glazing area by direct view of the skySource: (Reinhart and LoVerso, 2010)

(Fig. 2.6)- Angle of visible skySource: (Reinhart and LoVerso, 2010)

Aglazing . . R

Atotal

x1

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vertical shading devices. West and east windows are problematic for shading in the summer due to the sun being located at a low angle (CPWD, 2013). Neither vertical fins nor horizontal overhangs could contribute to complete shadings for west and east orientations and only a ‘frame’ which is a combination of both horizontal and vertical shading devices can effectively shade these orientations (Givoni, 1998).

To conclude, the natural cycle can be integrated and coalesced with the healing environment. Patients need to have an access and a sense of the outdoor environ-ment and condition. They should actively engage in outdoor activities to benefit from the outdoor natural elements (Huelat, 2008).

(fig. 2. 7)—Building orientation for hot-arid climatesSource: (CPWD, 2013) `Integrated Green Design for Urban & Rural Buildings in Hot-Dry Climate Zone´

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2.2.2 Natural Ventilation

Natural ventilation can compensate for and cast aside mechanical cooling sys-tems and bring into play the existing window openings in a room. It ensures a fresh and comfortable indoor climate. Natural ventilation has several advantages and benefits but also several factors affect its effectiveness. Natural ventilation is not a modern technique used in modern buildings but, it has been used in ancient times for the provision of a comfortable indoor habitat in the built environment (Ismail and Rahman et al., 2012).

The optimum or proper window design is followed with not only proper daylight and view but also ventilation which is followed by cooling when external tem-peratures are lower than that of the internal environment and hence, thermal comfort (REEEP, 2010).

Mechanical forces are sometimes used along with natural forces only when nat-ural ventilation is not sufficient to provide an optimum indoor thermal environ-ment. This is called Hybrid ventilation and is also known as mixed mode ventila-tion since it is a combination of both forces (Kleiven, 2003).

Natural ventilation may contribute to (Ghiaus and Allard, 2005);

• Decreases concentration of indoor pollutants (could only be achieved when outdoor pollutants are less than indoor pollutants)

• Provides indoor thermal comfort (could only be achieved when outdoor tem-perature is within comfort limit)

• Decreases energy consumptions of air conditioned buildings

2.2.2.1 Driving forces for natural ventilation (Ghiaus and Allard, 2005) ;

a. Wind driven

The pressure generated on the skin of the building by the wind results in the wind driven ventilation (Kleiven, 2003).

b. Buoyancy driven (Thermal Bouyancy)The difference in densities between warmer and cooler air volumed in the indoor

37


environment and the outdoor environment is what underlines thermal buoyancy (Kleiven, 2003). How-ever, A combination of both natural forces, wind and bouyancy driven could be incorporated in the design (Johnson, Zhai and Krarti, 2012).

2.2.2.2 Strategies of natural ventilation (Ghiaus and Allard, 2005);

• Single-sided ventilation • Cross ventilation• Stack ventilation

a. Single-sided-ventilation

Single-sided ventilation is induced by wind variation (Ghiaus and Allard, 2005).Air exchange in the room occurs in a way that air enters and exits the room from openings on one side. The air inflowing is the different masses of air or wind flowing near the open-ing of the window at different speed (P. Stabat , M. Caciolo, D. Marchio, 2012). It is the most localized and ensures a comfortable indoor climate when used for ventilating individual rooms (Ghiaus and Allard, 2005) but only to a limited depth which according to the rule of thumb: the depth of the rooms should be less than twice the room height (D< 2H).

Driving forces affecting single-sided ventilation (Ghiaus and Allard, 2005);

• Wind driven• Bouyancy driven

This could be explained by understanding the so called ‘pumping effect’ that is produced near the win-dow opening as a result of fluctuating components of

(Fig.2.8)- Single-sided ventilation air flowSource:(Commercialwindows.org, n.d.)

(Fig.2.9)- Wind Driven - single-sided ventilationSource: (Ghiaus and Allard, 2005)

38


wind. However, in the case of temperature difference between the internal and external environment, the buoyancy makes the cold air enter near the sill of the window and the hot air flows out near the head of the opening (Ghiaus and Allard, 2005).

Strategies of Single-sided ventilation (Ghiaus and Allard, 2005);

• Maximum room depth = 2.5 m times the height• Approximate window height = 1.5 m• Window area = 1/20 of the floor area

Wingwalls

Pressure could be created to improve the wind cir-culation in the single-sided ventilation technique by the addition of wing-walls (P. Stabat , M. Caciolo, D. Marchio, 2012).

b. Cross-Ventilation

Cross ventilation is air crossing the room, entering from one opening and leaving from another open-ing. The second opening can be positioned in various ways and can either be windows or doors (P. Stabat , M. Caciolo, D. Marchio, 2012). Cross ventilation is driven by differnces in pressure. Wind flowing on the windward surface induces positive pressure leaving the leeward surface with negative pressure. Thus, a pressure difference is created between both surfaces which causes the air flow when opposite openings are created since the air is forced to flow from high to low pressure (Ghiaus and Allard, 2005). The drawback of cross ventilation is the spread of air pollutants along the areas to be ventilated by the adjacent openings since air is transferred from one space to the other

(Fig.2.10)- WingwallsSource: (P. Stabat , M. Caciolo & D. Mar-chio, 2012)

(Fig.2.11)- Cross ventilation air flowSource: (Commercialwindows.org, n.d.)

(Fig.2.12)- Wind driven - cross ventilationSource: (Ghiaus and Allard, 2005)

39


(Ghiaus and Allard, 2005).

Cross-Ventilation depends on; (Ghiaus and Allard, 2005);

• Building form• Urban environmnet

c. Stack-Ventilation

Stack ventilation is a chimney-like process that cre-ates a natural convection current that does not re-quire fans. It involves the circulation of air through the entire internal environment of the building (Ghiaus and Allard, 2005). Since cold and dry air are denser than warm and humid air, cold air enters a space through openings at the bottom and warm air leaves the building through upper openings. Stack ventilation do not require specific openings however, any openings could be used. It is preferable to have large openings and increased vertical distance be-tween the lower and upper openings as this increases the airflow rates. The top opening should be placed in the low-pressure façade in order for the wind and stack pressure to work in the same direction (Ghiaus and Allard, 2005). The correct design of stack venti-lation depends on the neutral pressure level (NPL). This is the level responsible for balancing the airflow rates that enter and exit the building and tends to place itself closer to the largest openings. It depends on size and location of openings and indoor and out-door temperatures. The higher the upper opening, the higher the NPL and therefore the higher the fresh air reaches the upper part of the building (Ghiaus and Allard, 2005).

Limitations such as privacy concerns are faced with

(Fig.2.13)- Flow of cross ventilationSource: Author, adapted from (Ghiaus and Allard, 2005) text explanation

(Fig.2.15)- Stack effect- various ways for cooling upper levelSource:(Ghiaus and Allard, 2005)

(Fig.2.14)- opposite effects of wind and stackSource:(Ghiaus and Allard, 2005)

40


the cross and stack ventilation making it not as easy to implement in all building usages were privacy is a main requirement such as in hospitals. However, Sin-gle-sided ventilation would be more efficient (P. Stabat , M. Caciolo, D. Marchio, 2012).

Stack Ventilation depends on (Ghiaus and Allard, 2005);• Building form• Internal layout• 2.2.2.3 Natural Ventilation Quantification

a. Air flow rate

Air flow rate is measured in cubic meters per second and simply it is the air speed multiplied by the area of the opening. According to (Goma’a,2014), the following equation is used to calculate the airflow rate;

Q = 0.02 * Vspeed * Aopening (2.5)

Q= Air flow rate (m3/s)V= Wind speed (m/s)A= Area of openings (m2)

Factors influencing the air flowing through openings (P. Stabat , M. Caciolo

& D. Marchio, 2012);

• Wind speed• Wind direction• Wind fluctuations • Opening size, shape and position• Building geometry and context

b. Ventilation rate (Q)

The ventilation rate is measure in L/d/P (litres per second per person) or ACh (Air change rate per hour). Air change rate is the amount of replacements of a complete volume of air each hour

41


The pressure variance that is produces by the wind speed and by the unsteady air movement created at the opening of the window directs the ventilation rate (P. Stabat , M. Caciolo & D. Marchio, 2012).

The air change rate is calculated using the following equation; (Goma’a,2014)

(2.4)

Parameters affecting the air change rate (P. Stabat , M. Caciolo, D. M a r -chio, 2012);

• Wind velocity • wind direction• wind fluctuations • opening size• opening shape• opening position • building geometry and context

To conclude, according to the Building and Construction Authority (BCA) green mark scheme of healthcare facilities state that in naturally ventilated spaces the minimum wind speed must be 0.6 m/s. Moreover, according to British hospital standards, a minimum ventilation rate of 6 air changes per hour is recommended (Wu, 2011).

2.2.3 Views

Views of nature vary from one country to the other depending on the different context. Ordinarily, healthcare environments are accompanied with feelings of fright, anxiety, stress and doubt (Dijkstra, 2009). Since views of nature are in-stinctively of interest to human beings than urban views, these natural views pos-itively provoke humans’ emotions and psychological state such as, curtail stress (Urlich, 1984).Gardens in hospital that conform to appropriate designed guide-lines does not only present pleasant views of nature with soothing effects, but also contribute in stress reduction and progress in clinical outcomes (Ulrich, 2002).

Q * 3600ACh =

V

42


The natural scenes that are conveyed from the outdoor natural environment act upon recovery and patients’ wellbeing (Urlich, 1984). Long term patients in a hospital need to be affiliated with the outdoors natural environment since they are called for staying for a long period of time in a room (Ghisi E.,Tinket J.,2001). Some studies have investigated and lead to believe that views of nature have positive impact on both the duration of stay in the hospital and the amount of medication required. According to (Urlich, 1984) two surgical patients were accommodated in two different rooms with two different views, one with a view overlooking a brick wall and the other with a view overlooking trees. Two nurses evaluated their postoperative stay without knowing which patient had the view of trees and which had the view of bricks. The patient with the view of trees has fewer negative comments, a shorter hospital stay and few analgesic doses.

According to (Ulrich, 2002), a few minutes of exposure to nature can result in stimulating recovery from stress. Researches have suggested that patients whom are intensely stressed in hospitals can have their health or stress condition re-stored by viewing settings of nature.

Levels of positive psychological and emotional feelings are escalated from views of nature such as gardens and negative ones are dropped. Interest and attention are effectively sustained from certain scenes of nature and therefore, assist in distractions from stress. Clinical investigations found that, viewing nature for less than five minutes result in positive physiological changes such as decrease in blood pressure (Ulrich, 2002).

Windows designed for the provision of an outdoor view should be designed to be in the range of more than 1 m and less than 2.2 m.

1 m < vision window height <2.2 m (REEEP, 2010)

2.3 Biodiversity and Landscape2.3.1 Biodiversity

Humanity is exalted not because we are so far above other living creatures, but because knowing them well elevates the very concept of life.’ (Wilson, 1984, pg.22)

According to (Wilson, 1984) biodiversity refers to the variety of species wheth-

43


er plants or animals. The natural world and natural process are comprehended through understanding biodiversity. Healing is reinforced by the assortment of the nature and thus biodiversity. It forms the basis and grounds of physical con-dition and healthiness of human beings.

Biodiversity is vital for human beings existence. It is of great important to the health of an ecosystem, because greater variation means a healthier system. It is essential as it satisfies basic human needs for food and livelihood security and hence, offers a wide range of advantages to human health and wellbeing. Un-fortunately, they are devalued and downgraded within communities (UN-Cohab, 2010).

Biodiversity is important in an ecosystem for several reasons such as, balanc-ing atmospheric gases as helps in the absorption of greenhouse gases. Moreover, its importance goes beyond the provision of a variety of food, crop production, maintenance of air and water quality. It can help people find better cures for illnesses. Therefore it is important for the production of medicinal drugs which come from plants in a bio diverse ecosystem. Besides, it plays a role in the reg-ulation and control of infectious diseases and has social, cultural and spiritual importance within communities (UN-Cohab, 2010).

‘Because species diversity evolves prior to humanity, and because we evolved within it, we have never fathomed its limits. As a consequence, the living world is the natural domain of the most restless and paradoxical part of the human spirit. ’ (Wilson, 1984, pg.10)

2.3.2 Landscape

Landscape is an area of land with natural sceneries or elements (McGarigal, n.d).It has the ability to reduce stress and boost human beings comfort and physical condition as people drift towards natural elements (Molthrop, 2011).

Landscape has the ability to bring together all natural elements and allow its us-ers and viewers to mingle with nature. A garden is a lively, multi-coloured area and is always found as a resourceful approach by those planning a healing envi-ronment (Huelat, 2008).Monasteries developed intricate gardens during the middle ages in Europe to

44


convey images of calming distraction to the ill (Ulrich, 2002).

According to (Huelat, 2008) gardens offer several benefits to healthcare facilities:

• Curtails stress and depression to hospital users• Valuable and more desirable quality• Decreases pain• Boosts up patient contentment • Improves staff work productivity

Plants effectively purify and filter the environment, as they absorb atmospheric gases and release oxygen therefore, they purify the air from the existing pollut-ants (Huelat, 2008). Their function encompasses releasing moisture, to prevent dryness.

A persuasive relationship is the definition for that with plants, and including plants in the healing environment designs is the simplest way to support it (Hue-lat, 2008). As previously mentioned, landscape has positive psychological effects on human beings (Massawe and Vasut, 2013). The addition of indoor plants in health-cares has a valuable effect on patients (Beukeboom, Langeveld and Tan-ja-Dijkstra, 2012).

2.4 water

2.4.1 Water Features

‘‘Water is the supreme sculptor of our environment’’ - Craig Campbell 1

According to (Kellert, Heerwagen and Mador, 2008), water plays an important role in our everyday life enhancing human beings existence. Water could provide thermal comfort in the summer and unstiffens the roughness of the surrounding environment. It naturally has an organic form and boundaries and this is what causes and increases its biophilic potentials. An act towards the biophilic qual-ities water offers is requisite to be used to aid in designing a more pleasant and satisfying environment. Moreover, the existence of water assists in improving and embellishing the built environment. Recently, the attempts exerted to utilize water were only for amusement, leisure and aesthetic desirability. However, a

45


diminutive venture to integrate water with the landscape available in the open spaces of buildings has also been recently practiced and this is due to its mobile propoerties.

The biophilic distinctiveness of water is broadcasted and manifested through its interfaces and this strong identity is articulated in several ways such as;

• The surface of the water• Water interacts with sunlight• Water interacts with many natural materials to enhance the experience of

contact.• Moving water has very strong biophilic attraction • As a primary life-sustaining force, water’s significance is dramatized by the

addition of flora.

“Gardens can be healing and restorative via a number of mechanisms. The most obvious is the aesthetic of nature; that is, creating a beautiful, ver-dant place that will be a powerful enticement to go outdoors. Being out-doors in a natural or quasi-natural setting, experiencing sunlight, viewing trees, and listening to the sounds of water or birdsong—the combination of these and other elements that make up a garden can have a measurable stress-reducing benefit” (Huelat, 2008).

2.4.2 Water in motion

The mobility or flow of water is the ground for its musical sound scope with the ability to vary in sound sequentially (Kellert, Heerwagen and Mador, 2008). The significance of music to human beings and the melodic and harmonious abilities of water, give it its prohibitive biophilic individuality. One is tempted and cap-tivated by the sound and motion of water. Water has a soothing, restful effect and besides, a feeling of spirit renewal (Huelat, 2008). Biophilia is in action as human beings are merely emotionally magnetized to water and its characteristics and this is why water elements have been a pivot in health cares (Huelat, 2008).

2.5 Built Form

A health facility can be efficaciously operative but, psychologically imprudent

46


setting its aspects aside or in other words, psychologically ‘hard’. These hard fa-cilities are ineligible to the psychological needs of hospital users and therefore, fail. Scientific evidence has proven that, in certain cases poor design militates against the well-being of patients. Furthermore, researches affiliates poor health conditions such as, anxiety, delirium and high blood pressure with poor design (S. Ulrich, n.d., pp. 97-109).

Within this setting, the design should ensure health-cares that are not only com-petent in terms of functional efficiency but also pleasant in terms of psychological efficiency. Health-care environments that are entitles as ‘hard settings’ act as a barrier to muddle through stress. The visual features or elements found in the interior environment of health facilities have physiological and health related in-dicators and researches have strongly focused on these effects. It is also proven that the immune system has its function affected from stress. This immune mal-function leads to escalating vulnerability to diseases (S. Ulrich, n.d., pp. 97-109).

Natural materials contributes to a healing environment (Huelat, 2008). Colour affects human behaviour and is one of the factors to be considered when con-trolling stress. Human beings emotional state is strongly affected by the colour of the room or environment they are in. A poorly designed healing environment would develop stress to patients, visitors and staff. It has been investigated that colours affect the healing status of patients and also the productivity of the healthcare staff (Zraati, 2012).Some colours promote a relaxing and calming en-vironment and other promote a restless environment followed with a short stay.

Researches on the psychological effects of colours on human beings emotions have been carried. In most healthcare settings, this inquiry is unfortunately ne-glected. Studies have claimed that colours and emotions are directly proportion-al to one another, having warm colours such as red and yellow hues manifest provoking and irritating emotional state. Exhilaration, affliction and disappoint-ment are a state of mind of a human being when present in an orange interior environment. However, cold colours such as blue and green hues declare sooth-ing and restful state of mind. This outcome is enlightened by having the colour green being related with nature and trees. Colour is one of the imperative interior environmental qualities that is psychologically supportive and can easily shape the ambiance (Dijkstra, 2009).

47


Additionally, according to (Dijkstra, 2009), soft tone colours are the most pref-erable to be used for the colours of walls. These include colours such as yellow, green or blue. This is due to the fact that it promotes a calming and relaxing feeling. Moreover, light tones and warm colours such as white, cream and light grey are favoured for the flooring colours. Relaxing and calming settings con-tain colours such as pink and blue. A feeling of stability and security is followed with the brown colour. Self-confidence is fostered and optimism is encouraged with the presence of the yellow colour in the indoor environment. Even though ceilings are preferred to be in white but, the excess of white can give a feeling of separation and can promote a cold environment.

2.6 A framework for Biophilic Design

Based on the literature reviews and subsequent to analytical examples that used biophilic design, a detailed table (table 2.2) of biophilic design elements along with their strategies was formed as the conclusion and main guiding tool that will be used throughout working on the case study.

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• In

crea

se p

rodu

ctiv

ity

• R

educ

e ab

sent

eeis

m

• C

ontr

ibut

e to

gen

eral

wel

lbei

ng

Ligh

t im

pact

s hu

man

hea

lth

and

wel

l-be

ing

in d

iffer

ent w

ays;

• E

asin

g th

e pe

rfor

man

ce o

f vis

ual t

asks

• C

ontr

ollin

g th

e bo

dy’s

cir

cadi

an s

yste

m•

Affe

ctin

g m

ood

and

beha

viou

r•

Faci

litat

ing

dire

ct a

bsor

ptio

n fo

r cr

itic

al C

hem

ical

rea

ctio

ns

wit

hin

the

body

• Pr

oduc

tion

of v

itam

in D

in th

e bo

dy•

Stim

ulat

ion

of a

n an

tide

pres

sant

cal

led

‘s

erot

onin

’ nat

ural

ly fo

und

in th

e hu

man

bod

y•

Supr

essi

ng a

sle

ep in

duce

r ca

lled

‘mel

aton

in’ n

atur

ally

foun

d in

the

hum

an b

ody

To im

prov

e or

con

trol

day

light

qua

ntit

ies;

. 1Li

ght S

helv

es

. 2Sh

adin

g de

vice

a.

Int

erio

r

b. E

xter

ior

. 3To

p lig

htin

g

a.

Cle

rest

ory

b.

Roo

f mon

itor

c.

Saw

toot

h

d. S

kylig

ht

Nat

ural

lig

ht f

rom

a w

indo

w w

ill o

nly

reac

h si

x m

eter

s in

to a

ro

om a

nd a

win

dow

hea

d he

ight

of

3.7m

abo

ve t

he fl

oor.

• D

aylig

ht w

ill p

enet

rate

onl

y to

a d

epth

of 2

-2.5

x t

he h

eigh

t of

th

e w

indo

w h

ead

abov

e th

e w

ork

plan

e.(r

oom

dep

th)

• 8%

<O

vera

ll ar

ea o

f the

win

dow

s<20

% (

of th

e ro

om a

rea)

1. T

here

fore

, lig

ht

shel

ves

are

used

to

enha

nce

the

qual

ity

of

dayl

ight

in

the

room

.

• H

> 2

.2m

• A

ligh

t fini

sh to

max

imiz

e th

e re

flect

ion

of d

aylig

ht•

Max

imum

dep

th (0

.76

m)

• M

axim

um s

pan

of (

1.83

m)

Exc

ess

sola

r ga

ins

may

res

ult i

n an

unc

omfo

rtab

le e

nvir

onm

ent.

2. T

here

fore

, sh

adin

g d

evic

es a

re u

sed

to c

ontr

ol t

he e

xces

s so

lar

radi

atio

n en

teri

ng a

roo

m t

hrou

gh t

he w

indo

w

Hor

izon

tal d

evic

es

wit

h s

cree

nin

gV

erti

cal

dev

ices

6m

h

Tan

-90x

= W

/(H

1 - H

2)Ta

n -9

0x =

W/H

Tab

le 2

.2: A

fra

mew

ork

for

Bio

ph

ilic

Des

ign

49


Ele

men

ts o

f B

D

1b. N

atu

ral

Ven

tila

tion

Str

ateg

ies

Des

crip

tio

n o

f h

ow

it im

pact

s h

ealt

h

Met

ric

for

mea

suri

ng d

aylig

ht p

erfo

rman

ce;

•D

ayli

ght

Fac

tor

(DF

)

(Are

a of

Win

dow

(s)*

Ang

le o

f vis

ible

s

ky*T

rans

mit

tanc

e of

gla

zing

)

(A

rea

of a

ll in

tern

al s

urfa

ces)

x

1D

F =

3. T

op l

igh

tin

g is

use

d to

fur

ther

enh

ance

the

day

light

in

the

room

a. C

lere

stor

y

b. R

oof

mon

itor

c. S

awto

oth

d. S

kyli

ght

3-8%

of t

he fl

oor

area

wit

h 1.

5 x

H m

spa

cing

Nat

ural

ven

tila

tion

wou

ld c

ompe

nsat

e fo

r an

d ca

st a

side

mec

han-

ical

coo

ling

syst

ems

and

brin

g in

to p

lay

the

exis

ting

win

dow

ope

n-

ing

in th

e ro

om. I

t ens

ures

a fr

esh

and

com

fort

able

indo

or c

limat

e.

The

thre

e m

ain

type

s of

nat

ural

ven

tila

tion

are

;•

Sing

le-s

ided

ven

tila

tion

•

Cro

ss v

enti

lati

on

• St

ack

Effe

ct

a. S

ingl

e-si

ded

Ven

tila

tion

d<2h

Sect

ion

d

h

Win

gwal

ls

50


Ele

men

ts o

f B

D

1c. V

iew

Str

ateg

ies

Des

crip

tio

n o

f h

ow

it im

pact

s h

ealt

hTh

e di

agra

m b

elow

exp

lain

s ho

w th

e di

ffere

nt ty

pes

of n

atur

al

vent

ilati

on a

re c

ateg

oris

ed;

Nat

ural

Ven

tila

tion

Win

d D

rive

n(P

ress

ure

Indu

ced)

Sing

le-

side

dve

ntila

tion

Sing

le-s

ided

vent

ilati

onC

ross

Ven

tila

tion

Stac

k E

ffect

Buo

yanc

y D

rive

n(T

emp.

indu

ced)

• A

ir fl

ow r

ate

Is m

easu

red

in c

ubic

met

ers

per

seco

nd a

nd s

impl

y it

is

the

air

spee

d m

ulti

plie

d by

the

area

of t

he o

peni

ng.

• A

ir c

han

ge r

ate

Air

cha

nge

rate

is th

e am

ount

of r

epla

cem

ents

of a

com

plet

e vo

lum

e of

air

eac

h ho

ur

No

max

imum

dis

tanc

e, o

nly

adja

cent

ope

ning

s ar

e re

quir

edb.

Cro

ss V

enti

lati

on

Vie

ws

of n

atur

al e

lem

ents

pos

itiv

ely

prov

oke

hum

an b

eing

s fe

elin

g an

d ps

yhco

logi

cal s

tate

. Rec

over

y an

d pa

tien

t’s w

ellb

eing

act

upo

n th

e na

tura

l sc

enes

tha

t ar

e co

nvey

ed f

rom

the

out

door

nat

ural

en

viro

nmen

t.

Air

flow

Rat

e (Q

):

Q =

Air

spe

ed *

Are

a of

ope

ning

Air

ch

ange

rat

e (A

Ch

):

AC

h=Q

* 3

600

V

c. S

tack

Ven

tila

tion

Sect

ion

Stack height

Sect

ion

Stack height

Sect

ion

Stack height

• W

indo

ws

shou

ld b

e ca

refu

lly d

esig

ned

for

the

prov

isio

n of

vi

ews

of n

atur

al,

outd

oor

scen

es.

• C

aref

ully

pla

n th

e si

ghtl

ines

and

avo

id e

xter

nal o

bstr

ucti

ons

• If

not

a c

urta

in w

all t

hen,

win

dow

s sh

ould

be

in t

he fo

llow

ing

rang

e ;

1m <

Vis

ion

win

dow

hei

ght <

2.2

m

• M

any

win

dow

s as

pos

sibl

e sh

ould

look

out

ove

r na

tura

l fe

atur

es

51


Ele

men

ts o

f B

D2.

Bio

div

ersi

ty &

L

and

scap

e

3. W

ater

Fea

ture

s

4. M

ater

ials

& C

olou

r

Str

ateg

ies

Des

crip

tio

n o

f h

ow

it im

pact

s h

ealt

hB

iodi

vers

ity

refe

rs t

o th

e va

riet

y of

spe

cies

whe

ther

pla

nts

or

anim

als.

•

Bio

dive

rsit

y is

impo

rtan

t in

an e

cosy

stem

bec

ause

it b

alan

ces

atm

osph

eric

ga

ses

as

plan

ts

help

in

th

e ab

sorp

tion

of

gr

eenh

ouse

ga

ses.

•

The

prov

isio

n of

a v

arie

ty o

f foo

d(cr

op p

rodu

ctio

n)•

mai

nten

ance

of w

ater

qua

lity

• It

hel

ps p

eopl

e fin

d be

tter

cur

es f

or il

lnes

ses

and

impo

rtan

t fo

r th

e pr

oduc

tion

of

med

icin

al d

rugs

whi

ch c

ome

from

pl

ants

in

a bi

o di

vers

e ec

osys

tem

. •

It p

lays

a r

ole

in t

he r

egul

atio

n an

d co

ntro

l of

inf

ecti

ous

dise

ases

and

has

soc

ial,

cult

ural

and

spi

ritu

al i

mpo

rtan

ce

wit

hin

com

mun

itie

s.

• O

utdo

or n

atur

al a

reas

wit

h ri

ch v

eget

atio

n an

d an

imal

s •

Nat

ive

plan

ts a

re p

refe

rred

to s

uppo

rt d

iver

se e

ccos

yste

ms

• Des

ign

shou

ld in

corp

orat

e th

e pr

esen

ce o

f pla

nts i

n th

e in

tern

al

envi

ronm

ent a

nd g

arde

ns in

the

outd

ooor

env

iron

men

t. e.

g:

• B

iow

all (

Ext

erna

lly o

r In

tern

ally

) to

rem

ove

air

pollu

tant

s•

Plan

ter

boxe

s (E

xter

nally

or

Inte

rnal

ly)

• In

ner

cour

t (E

xter

nally

or

Inte

rnal

ly)

• G

arde

ns (I

n up

per

floor

s)•

Gre

en r

oof (

visu

al a

nd p

hysi

cal a

cces

s)

• W

ater

nat

ural

ly h

as a

n or

gani

c fo

rm a

nd b

ound

arie

s an

d th

is

is w

hat c

ause

s an

d in

crea

ses

its

biop

hilic

pot

enti

als.

•

Soun

d of

wat

er h

as t

he a

bilit

y to

cre

ate

mus

ical

sou

nds

com

preh

ensi

ble

to h

uman

s its

elf a

hig

hly

biop

hilic

hum

anis

tic

trai

t. M

ovin

g w

ater

has

ver

y st

rong

bio

phili

c at

trac

tion

s as

w

ell

as c

alm

ing

effec

ts.

• In

corp

orat

e w

ater

fea

ture

s in

the

bui

lt e

nvir

onm

ent

as w

ater

fe

atur

es h

ave

visu

al a

nd a

cous

tic

bene

fits

Col

our

affec

t hum

an b

ehav

iour

, con

trol

ls s

tres

s, a

ffect

the

heal

ing

stat

us o

f pa

tien

ts.

Hum

an b

eing

s em

otio

nal

stat

e is

str

ongl

y aff

ecte

d by

the

col

our

of t

he r

oom

or

envi

ronm

ent

they

are

in.

• So

ft to

ne c

olou

rs a

re th

e m

ost p

refe

rabl

e to

be

used

for

the

colo

urs

of w

alls

. The

se in

clud

e co

lour

s su

ch a

s ye

llow

, gre

en

or b

lue.

• Li

ght

tone

s an

d w

arm

col

ours

for

the

floo

ring

col

ours

. Th

ese

colo

urs

incl

ude

whi

te,

crea

m a

nd l

ight

gre

y.

53

analytical study

Chapter 3Analytical Study

3.1 Introduction and study scope

Deducing and deriving the guidelines of biophilic design from the literature re-view is not adequate. However, analysing examples that used biophilia in their design was intended to further authenticate these elements. This chapter aims at providing a revalidation or authentication to the deduced guidelines of BD through analysing examples of healthcare facilities that incorporated biophilic elements and attributes in their design.

The examples are;

• Example 1: Khoo Teck Puat Hospital, Yishun, Singapore • Example 2: Palomar Medical Center West, Escondido, California

A general description to every hospital is first presented. Subsequently, analytical study to the elements implemented in inpatient rooms of every example will be illustrated followed by an assessment to one of the rooms or wards for its evalu-ation. The discussion of the results aims at giving the necessary assumptions and suggestions for further improvement. Finally, a comparison will then be made between the results of the assessed inpatient rooms of every example to elucidate the similarities and differences.

54


3.2 Khoo Teck Puat Hospital, Yishun, Singapore (KTPH)

‘‘ These trials have been imperative to modern hospital design and the incor-poration of biophilic design, the best example of which is Singapore’s Khoo Teck Puat Hospital (KTPH) ’’ (Clancy, 2013)

3.2.1 General description of the project

KTPH is a winning of a ‘hassle-free’ hospital design competition, designed by CPG Consultants. It is a hospital completed in 2010 being the first communal hospital to be constructed in Singapore during the last 10 years. The hospital is owned by the government and its fees are commensurate with other public hos-pitals in singapore. KTPH has been funded by the Ministry of Health along with donation to support patients in need, education, research in order to advance healthcare(Alexandra health in action, 2010). KTPH is a hospital consisting of 550 beds and 19 wards. These wards are divided into 8 private wards, 10 Subsi-dised, 1 classless Isolation Ward. The wards are distributed amongst two towers, tower A (private wards) and tower B (subsidised wards). KTPH also consists of 17 clinics with 90 consultation rooms. (Ktph.com.sg, n.d.)

(fig.3.1) KTPH perspective across Yishun pondSource: (Cooper.edu, 2014)

55

analytical study

3.2.2 Urban context

The hospital is located in Yishun, which is a suburban town in the northern part of Singapore. It is sited in the Yishun Central and lies on a 3.4 hectar site and is located adjacent to the Yishun pond(National Library Board, 2014). The hopital being located next to the Yishun Pond (Alexandra health in action, 2010) aims at enriching approachability or accessibility, enhance the quality of water, bring into existence new green spaces and inspirit an active lifestyles within the com-munity (Housing and development board, 2011).

(fig.3.4) KTPH circulation path Source:(Bg4fsvirginia.wordpress.com, 2013)

(fig.3.2) KTPH site planSource: Google Earth

(fig.3.3) KTPH zoningSource: adapted from (Wu, 2011)

(fig. 3.5) KTPH floor plan of naturallz ventilated wardSource: (Wu, 2011)

56


(fig. 3.6) KTPH floor plan of air-conditioned wardSource: (Wu, 2011)

• Subsidised wards orientations

The orientation of the inpatient rooms in the subsidised wards are located along the inner court which also overlooks the Yishun pond and also in the opposite direction. However, the planter boxes that are placed outside ever inpatient room bring the garden inside the room and provides a scenic view of nature which thus creates a relaxing environment.

• Private wards orientations

The All of the inpatient rooms in the private wards are aligned in a way to over look the court and the pond. However, those aligned on the sides will no have a clear view but alike the subsidised wards the rooms are also provided with planter boxes which brings the patients closer to nature.

57

analytical study

3.2.3 KTPH: Biophilic design elements analysis

3.2.3.1 Natural Daylight

• Light shelves: light shelves are placed internall and externally to allow light to be bounced up to-wards the ceiling then reflected down deeper into the interior of a room.

• Sunshading technology: They are used on the east and west facades and are designed with low-E glass to reduce solar gain and avoid patients’ dis-comfort.

Daylight FactorReferring to the daylight factor equation 2.3 in sec-tion 2.2.1.9 ‘Daylight Factor’,

• aCw• ATotal of all internal surfaces=2(7.14x3)+2(2.75x3)+2(2.86x3)+ (4 x 3)+ (9.5 x 3) + (Afloor= 80.4 m2) + (Aceiling= 80.4 m2) = 277.7 m2

• Awindow=17.8 m2

DF=

• nvw• ATotal of all internal surfaces= 117 m2 + Afloor= 85.0)+(Aceiling = 85.0 m2)=287m2 • Awindow=17.8 m2

DF=

(fig.3.7) Simplified arhcitectural plan of the 4-bed air-conditionned inpatient ward showing the different depth of the wardSource: Author

(fig.3.8) Simplified arhcitectural plan of the 4-bed air-conditionned inpatient ward showing the different depth of the wardSource: Author

17.8 * 55 * 0.8

287x 1 = 2.73%

17.8 * 55 * 0.8

277.7x 1 = 2.82%

10.0

m7.14

m2.

86 m

(fig.3.9) Typical strip section of ACW and NVWSource: (Skyrisegreenery.com, 2014)

1.20

m0.

60 m

55o

1.20

m

9.50 m

4.00 m2.75 m 2.75 m

10.0

m7.14

m2.

86 m

6.35 m

6.35 m

3.15 m

3.00

m

58


room depthDaylight is ideal when the room is 2 x H or 2.5 x H where H is the window head height. Since the height of the inpatient ward is 3m and the window head height of the ward is also 3m as the design of the hos-pital coalesces curtain wall in all inpatient wards then the rule requires a value of 2 x 3= 6m room depth or a maximum of 2.5 x 3=7.5m room depth.

• aCwThe overall depth of the ward is 10m which is ad-verse to the maximum depth. However, deducting the 2.86m of the toilet depth from the overall depth, 10 - 2.86 = 7.14m which is an auspicious result as it abides by the rule.

• nvwThe overall depth of the ward is 10.0 m. The areas of the entrance can not be deducted as one of the toilets of the ACW is substituted with a bed to increase the number of inpatients in the NVW..

Area of window to area of roomSection 2.2.1 ‘Daylight’ states that the window area should not be less than 8% of the overall room area and not exceed 20% of the room area.

• aCwThe area of the ward is (4x2.86)+(7.14x9.5)= 79.3 m2 and the glazing area is 3 x 9.5 = 28.5m, (28.5/79.3) x 100 = 34% of the overall room area.

•nvwThe area of the ward is (7.14x9.5)+(6.35x2.86) = 85.9 m2 and the glazing area is 3 x 9.5 = 28.5m, (28.5/85.9) x 100 = 33% of the overall room area.

(fig. 3.11) Colour gradient to show the de-crease in illuminance level in ACWSource: Author

(fig.3.10) External perspective of the wardSource: (Hospital Design- Singapore style, 2009)

(fig. 3.12) Colour gradient to show the de-crease in illuminance level in NVWSource: Author

0 m

0 m

2.5 m

2.5 m

5 m

5 m

7.5 m

7.5 m

10 m

10 m

59

analytical study

Light shelves

Light shelves are placed internally and externally in the wards. Referring to the literature review in chapter 2 section 2.2.1.4 ‘Light shelves’, the light shelves should be placed or mounted at a height that is greater than 2.2 m since this is where they are most useful. In both the ACW and the NVW the light shelves are places at a height of 2.4m.

3.2.3.2 Natural Ventilation

• ‘‘Fin’’ technology: Allows the enhancement of airflow by channelling the northeast wind inward.(ALPOLIC, 2013)

• Wing walls to increase natural ventilation

No shelfExterior shelf

Exterior and interior shelf

Daylit zone

Interior shelfExterior

shelf+Sun shade

(fig.3.14) Cross section diagram of ACW and NVW showing light bouncing on the interior and exterior shelf, reflecting it on the ceiling and deeper into the roomSource: Author

(fig.3.13) Cross section diagram of ACW and NVW showing the different iluminance level in case of the absence of the light shelf or the presence of the interior and exterior light shelfSource: Author

60


Since the private wards consist of non-operable win-dows as they are all air conditionned, the airflow rate nor the air change rate will not be calculated. Howev-er, all of the subsidised wards are naturally ventilated in addition to a fan above every patient bed to sup-port and aid in the ventilation process when needed.

a. Since the NVW are ventilated with a single-sided ventilation, then the depth of the room should not exceed 2.5 times the room height as mentioned in 2.2.2.4-a in the section of ‘Singe-sided ventilation’. The room depth is 7.14 m on the side with 2 beds and 10.0m on the side with 3 beds, which is less than the required value since 2.5 x 3 =7.5m.

Airflow rate (Q)Refering to equation 2.5 section 2.2.2.5-b, the air speed multiplied by the area of the opening and a co-efficient of 0.02 gives a value of the airflow rate (Q) and is measured in m3/s. In order to achieve the val-ue of the air speed, the average annual wind speed of Singapore (2.30 m/s) was calculated and used. The area of the opening is 9.50 x 1.40 = 13.3 m2. There-fore, Q = 0.02 x 2.30 x 14.0 = 0.61 m3 /s

Air change rate (ACH)The amount of replacements or exchange of a com-plete volume of air each hour is the air change rate (ACh) as mentioned in section 2.2.2.5-a equation 2.4. ACh = (Q x 3600)/(area x height) = (0.61 x 3600)/(85x3) = 9 air changes per hour.

3.2.3.3 View

Windows do not only function in a way to allow the provision of light nor to allow for natural ventilation. However, it is also necessary to convey natural scenes

(fig.3.17) 3D section of the naturally venti-lated subsidised inpatient wardSource: Author

Ven

tila

tion

inle

t an

d ou

tlet

(fig.3.16) Elevation of the inpatient ward showing the operable windowsSource: adapted from (Skyrisegreenery.com, 2014)

(fig.3.15) Elevation of the private inpatient ward showing the non-operable windowsSource: (Skyrisegreenery.com, 2014)

(fig.3.18) View to Yishun pondSource: (Blog.centerforinnovation.mayo.edu, 2014)

61

analytical study

from the outdoor natural environment. It was previously mentioned in the lite-rature review that the views of nature positively provokes humans´emotions and psychological state. As mentioned in section 2.2.3, windows designed for the pro-vision of an outdoor view should be above 1m and less than 2.2m and since cur-tain walls were incorporated in the design of the wards then, this rule is obeyed.

All inpatient wards, either the subsidised or the private wards, overlooks at the scenic view of the Yishun pond, the court and in addition to the planter boxes outside every inpatient room .

3.2.3.4 Biodiversity & Landscape

Biodiversity and landscape are strongly incorporated in the design of KTPH; (ALPOLIC, 2013), (Ktph.com), (Housing and development board, 2011)

• There are more than 16 landscaped areas in KTPH that include gardens in which they are planted along corridors.

• Courtyards at main lobby, foodcourt, auditorium • Patient-oriented gardens and terrace gardens at ICU level, and upper levels• Rooftop Gardens • The marshlands and floating wetlands consist of plants that absorb pollu-

tants which assists the water in the pond to have a better quality. These plants also boosts the biodiversity of the area by founding a natural habitat for na-tive fauna. The edge of the pond has been planted by native flower species to provide a unique garden experience for the garden users.

• The design included a local forested zones which incorporated native species of canopy trees to provide the users of the garden with shaded areas.

• The pond is considered as a safe port for an assortment of biodiversity.

(fig.3.19) CourtSource: (Futurarc.com, 2011)

(fig.3.20) Planter boxes outside patient rooms and between corridorsSource: (Futurarc.com, 2011)

62


(fig.3.23) Water features in site Source: (Futurarc.com, 2011)

• Stream and water feature were regarded as a chance to support the wildlife, with some 92 nati-ve species of fishes found there.

• To further complement the luxurious greenery of the hospital and regarding the pond as a natural extension to KTPH, the redevelopment of the Yis-hon pond and its surrounding took place.

• Medicinal Garden• 140 fruit trees are establish in an urban farm

which is situated on one of the rooftops.

3.2.3.5 water

Section 2.4 states that incorporating water features in the design is required as water has visual and acou-stic benefits. KTPH consists of gardens at the base-ment that consists of cascading waterfall and bio-ponds (Ktph.com.sg, n.d.). The Yishon pond (existed in the site before the existence of the KTPH but was redeveloped and considered as a natural extension to the site).

3.2.3.6 Built form

The built form encompasses the materials and co-lours used in the interior of the inpatient wards. Loo-king at the interior of the 4-bed ward, it is clearly seen that the flooring materials is timber which is a natural material which would make patients feel the sense of nature. The colour of the walls are white with purple floral patterns to also give a feeling of nature.Fig.40 is a perspective of one of the naturally ventilat-ed wards (not the ward being assessed). The floor is not made out of timber like that in the private ward. Thus, does not give a close feeling to nature through embedding natural materials in the ward.

(fig.3.21) Rooftop garden at KTPHSource: (Definition of Environment, 2013)

(fig.3.22) Meditiation garden at KTPHSource: (Bg4fsvirginia.wordpress.com, 2013)

(fig.3.24) Perspective a naturally venilated wardSource: (KTPH website)

63

analytical study

(fig. 3.26)Plan illustrating the similarities and differences between ACW and NVWSource: (Hospital Design- Singapore style, 2009) and (Skyrisegreenery.com, 2014)

Curtain wall allowing a direct view to the external natural environ-ment such as, inner court and Yis-hun pond.

External and internal light shelves to provide an even illumination gradient.

• Non-Operable windows in ACW•Operable, hinged windows in NVW

• Air conditioner slots in ACW • Fan located above every patient bed in NVW

• Toilet in ACW • 5th inpatient bed in NVW

(fig.3.25) Perspective of private air-conditioned wardSource: (KTPH website- /Ktph.com.sg, nd.) )

64


Ele

men

ts o

f B

D1.

i.e

.Q.

1a. d

ayli

ght

Str

ateg

ies

• L

ight

she

lves

•H

> 2

.2m

•A

ligh

t fini

sh to

max

imiz

e th

e re

flect

ion

of

d

aylig

ht

•M

axim

um d

epth

(0.7

6 m

) •M

axim

um s

pan

of (

1.83

m)

KT

PH

- A

C w

ard

KT

PH

- N

V w

ard

• D

aylig

ht fa

ctor

(DF)

- O

ptim

um =

3%

• R

oom

dep

th =

2 - 2

.5 x

H(w

indo

w h

ead

heig

ht)

• S

ingl

e-si

ded

Ven

tila

tion

; D =

2.5

h

• S

hadi

ng d

evic

eH

oriz

onta

l ove

rhan

g: S

un-

shad

e w

ith

low

-E g

lass

( al

so

exte

rnal

ligh

t she

lf)

2.82

%

34 %

Ava

ilabl

e

Not

ava

ilabl

eD

= 1

0.0

m

0.61

m3

9 A

CH

Not

ava

ilabl

e

Not

ava

ilabl

e

Plan

ter

boxe

s ar

e lo

cate

d ou

tsid

e ev

ery

inpa

tien

t roo

m. I

n

addi

tion

, cle

ar v

iew

to th

e Yi

shun

pon

d an

d th

e in

tern

al c

ourt

is

prov

ided

. The

str

ong

conn

ecti

on b

etw

een

the

inte

rnal

env

iron

-

men

t and

the

natu

ral e

xter

nal e

nvir

onm

ent i

s cl

earl

y tr

ansm

it-

ted

as a

res

ult o

f the

cur

tain

wal

l.

Ava

ilabl

e

2.4

m

Low

-E g

lass

0.7m

x 2

.4m

and

0.7

m x

2.6

m

Low

-E g

lass

2.4

m

33%

7.15

m7.

15 m

and

10.

0 m

2.73

%

• H

oriz

onta

l ove

rhan

g: S

un-

shad

e w

ith

low

-E g

lass

• M

onso

on lo

uver

s

• O

pera

ble

Jalo

usie

• A

irflo

w R

ate

(Q)

• A

ir c

hang

e ra

te (A

Ch)

• 8

%<

Ove

rall

area

of t

he w

indo

ws<

20%

1b.N

atu

ral

Ven

tila

tion

1c. V

iew

s

• M

any

win

dow

s as

pos

sibl

e sh

ould

look

out

ove

r na

tura

l fea

ture

s

• W

indo

ws

shou

ld b

e ca

refu

lly d

esig

ned

for

the

prov

isio

n of

vie

ws

of n

atur

al, o

utdo

or s

cene

s.

• C

aref

ully

pla

n th

e si

ghtl

ines

and

avo

id e

xter

nal o

bstr

ucti

ons

• If

not

a c

urta

in w

all

then

, w

indo

ws

shou

ld b

e in

the

fol

low

ing

rang

e ;

1m <

Vis

ion

win

dow

hei

ght <

2.2

m

Tab

le 3

.1: R

esu

lts

of K

TP

H in

pat

ien

t w

ard

ass

essm

ent

65

analytical study

Ele

men

ts o

f B

DS

trat

egie

s•

Nat

ive

flow

er s

peci

es a

re p

lant

ed in

gar

dens

and

roo

ftop

gar

-de

ns in

the

hosp

ital

as

wel

l as

alon

g th

e pe

rim

eter

s of

the

Yihs

un

pond

and

is c

onsi

dere

d as

a s

afe

har

bour

for

an

arra

y of

bio

di-

vers

ity

• A

n ex

tern

al v

erti

cal g

reen

wal

l is

foun

d in

the

hosp

ital

•

Plan

ter

boxe

s ar

e lo

cate

d ou

tsid

e al

l roo

ms

to p

rovi

de a

n ad

di-

tion

al v

iew

to n

atur

e.•

Med

itat

ion

gard

ens

and

gard

ens

are

acce

ssib

le t

o al

l ho

psit

al

user

s.• L

ocal

fore

sted

zon

es w

hich

inco

rpor

ated

nat

ive

spec

ies

of c

ano-

py tr

ees

to p

rovi

de g

arde

n us

ers

wit

h sh

aded

are

as

Wat

er f

eatu

res

are

pres

ent

in t

he g

arde

ns o

f K

TPH

allo

win

g th

e us

ers

to b

enefi

t fr

om t

he v

isua

l and

aco

usti

c be

nefit

s of

wat

er

2. B

iod

iver

sity

&

Lan

dsc

ape

3. W

ater

Fea

ture

s

4. B

uil

t F

orm

• O

utdo

or n

atur

all a

reas

wut

h ri

ch v

eget

atio

n an

d an

imal

s

• N

ativ

e pl

ants

are

pre

ferr

ed to

sup

port

div

erse

ecc

osys

tem

s

• D

esig

n sh

ould

inco

rpor

ate

the

pres

ence

of p

lant

s in

the

inte

rnal

en

viro

nmen

t and

gar

dens

in th

e ou

tdoo

or e

nvir

onm

ent.

• In

corp

orat

e w

ater

fea

ture

s in

the

bui

lt e

nvir

onm

ent

as w

ater

fe

atur

es h

ave

visu

al a

nd a

cous

tic

bene

fits

• B

iow

all (

exte

rnal

ly o

r in

tern

ally

)

• Pl

ante

r bo

xes

(Ext

erna

lly o

r in

tern

ally

)

• In

ner

cour

t

• G

arde

ns (g

roun

d an

d up

per

floor

s)

• G

reen

roo

d (v

isua

l or

phys

ical

acc

ess)

KT

PH

- A

C w

ard

KT

PH

- N

V w

ard

• So

ft t

one

colo

urs

are

the

mos

t pr

efer

able

to

be u

sed

for

the

colo

urs

of w

alls

. The

se i

nclu

de c

olou

rs s

uch

as y

ello

w, g

reen

or

blu

e.

• Li

ght

tone

s an

d w

arm

col

ours

for

the

floo

ring

col

ours

. The

se

colo

urs

incl

ude

whi

te, c

ream

and

ligh

t gr

ey.

• Fl

oor

mat

eria

l is

mad

e of

ti

mbe

r w

hich

giv

es a

feel

ing

clos

e to

nat

ure

sinc

e ti

mbe

r is

a

natu

ral e

lem

ent

• C

eilin

g an

d w

alls

are

whi

te in

co

lour

• Fl

oral

pat

ters

on

the

wal

ls

• Fl

oor

mat

eria

l is

not m

ade

of

a na

tura

l ele

men

t and

is w

hite

in

col

our

• C

eilin

g an

d w

alls

are

whi

te in

co

lour

66


3.3 KTPH: Discussion

The criteria for daylight factor in inpatient rooms is 3%. In the AC ward and the NV ward, the daylight factor is 2.82% and 2.73% respectively. With this value and in addition to the light shelves, the evaluation clarifies that the wards meet the optimal standard and therefore illustrates that they receive sufficient amount of daylight.

The room depth should not exceed 2 or 2.5 times the window head height. How-ever, since curtain walls are incoporated in the design of the wards, the window head height is the ward height which is 3m leaving the maximum depth of 7.5m. This clarifies that in the AC ward where there are only 4 beds and the entrance can be neglected leaving the room with a depth of 7.15 m instead of 10m. In the NV ward, a fifth bed exists leaving the room with a depth of 10m on one side and 7.15m on the other. This explains that the area of 5th bed would be dimly lit in the absence of light shelves.

Singapore is classified as a tropical rainforest climate and experiences a relatively high humidity reaching the range of 70-80% with an average temperature of 25 degrees Celsius and 31 degrees Celsius (Guidemesingapore.com, 2014). Howe-ver, the window area is 34% of the whole ward area which exeeded the optimal range of it having to be less than 8% and more than 20% of the total room area which means that excess solar heat gains could take place due to singapore´s high temperature and humid climate. Yet, the external light shelf is also used as a sunshade. Both, the external and internal light shelf is made of a low-e glass which means that it reflects radiant heat instead of allowing it to enter the ward and heat up the space.

As mentioned in chapter 2 , the minimum required air speed for naturally ven-tilated areas is 0.6m/s and a minimum of 6 ACH is required in inpatient rooms. The average annual wind speed in Singapore is 2.30 m/s which was calculated uing the table in appendix B. This high value of wind speed clarifies that the weather in Singapore is qualified to naturally ventilate the wards. However, after assessing KTPH inpatient room it was shown that it experiences 9 ACH which means that the airflow rate and the air change rate meet optimum standards.

67

analytical study

3.4 Palomar Medical Centre West, Escondido, California (PMC)

‘‘ The decision to include these biophilic elements is tightly coordinated with the institutions’ broader mission of delivering safe and efficient medical care, maintaining patient comfort, and ensuring staff satisfaction. ’’ (GON-CHAR, 2012)


The Palomar Medical Centre designed by CO architects which opened in 2012 is a 740,000 square feet hospital consisting of 11-story building with 288 private, single-patient rooms and more than 800 parking spaces. The first and second levels of the hospital houses 50 emergency & trauma rooms, 12 operating rooms and 6 interventional radiology suites (PMC website).

(fig. 3.27) Perspective of Palomar Medical Center Source: COarchitects website

According to (The health source, 2012) and (PMC facility guide), the aim was to

create of a high-performing hospital which coexists with nature has been the result

of forming a strong bond amongst the environmental awareness, advancements in

technology, evidence-based design, and a visionary client. Support healing through

natural processes was the target of the hospital. It focused on gardens, views of na-

ture, and natural ventilation. An adequate amount of researches have signified the

progressive healing benefits of endorsing firm connections to nature within the phys-

ical building.16 PMC is the perfect concept of sustainable and nature inspired design

model. It strongly highlights the stress-reducing and healing powers of nature.

68


3.4.2 Urban context

(fig. 3.28) PMC: Site PlanSource: PMC facility guide

69

analytical study

The context was strongly measured to provide the perfect setting for redefining what sustainable design means for hospitals and medical care. It is on located on more than 50 acre site. The surrounding landscape, hills and mountains are integrated in the design of PMC. The living roof on PMC mimics the surrounding hillsides, including undulating topography that creates microclimates which fa-vors a diverse mix of native plants (The health source, 2012).

The rooms in Palomar Medical Center are aligned on opposite directions. How-ever, the high land that PMC is built on provides a very clear and unobstructed view to the surrounding hills and valleys that surrounds the site.

(fig. 3.29) PMC: Typical architectural floor plan (4th to 9th floor)Source: PMC facility guide

70


3.4.3 PMC: Biophilic design elements analysis

3.4.3.1 Natural Daylight

• Expansive windows are designed in inpatient rooms to form a strong connection between the interior and exterior environment.

• The expansive windows provide an unobstructed views of the surrounding mountains and rolling hills.

• Sunshades - encourages the comfort of the family space in the patient room and the view to nature. This allows the patients to benefit from the nat-ural light all day which studies have shown im-prove patient healing.

• Advanced light fixtures and controls - hue and in-tensity can be altered through the advanced light fixtures and controls outfitted in patient rooms.

Daylight Factor (DF):

Referring once more to section 2.3, the daylight fac-tor in PMC inpatient rooms is;

ATotal internal surfaces= (2x2.6)+(1.90x2.6)+(0.90x2.6)+(4.30x2.6)+(0.40x2.6)+(1.14x2.6)+(0.40x2.6)+(1.80x2.6)+(0.14x2.6)+(1.02x2.6)+(1.17x2.6)+(3.6x2.6)+(6.68x2.6)+(0.73x2.6)+(0.20x2.6)+(AFloor= 24 m2)+(A-

Ceiling=24 m2) = 117 m2

AWindow= 3.6 m2

DF = (fig. 3.32) Perspective of an inpatient room in PMC showing the airflow as a result of single-sided ventilation Source: (U-T San Diego, 2011)

(fig. 3.30) Dimensions of inpatient room at PMCSource: PMC facility guide

3.6 *90 * 0.8

117x 1 = 2.22%

(fig. 3.31) PMC: inpatient room strip sectionSource: Author (adopted from room perspective)

90o

3.0

0 m

2.00 m

4.10 m

6.1

5 m

1.0

5 m

7.20

m1.

10 m

0.9

0 m

0.9

0 m0

.10

m

71

analytical study

(fig. 3.33) Daylight illuminance gradient planSource: Author

room depthAs previously mentioned that the room depth should be 2 times the window head height or a maximum of 2.5 times the window head height. 2 x 3 = 5.2m depth or taking the maximum value 2.5 x 3 = 6.5 m. The overall depth of the inpatient room is 7.20 m or 6.15 m excluding the entrance.

Area of window to area of roomIn chapter 2 and in the first analytical example, the window area should not be less than 8% of the overall room area and should not exceed 20% of the room area. The area of the room is 24 m2 and the glazing area is 3.6 m2, (3.6/24) x 100 = 15 % of the overall room area.

3.4.3.2 Natural Ventilation

Since the inpatient rooms in PMC use single-sided ventilation, then the depth of the room should not exceed 2.5 times the room height as mentioned in the strategies of ‘Single-sided ventilation’. The room depth is 7.25 m or 6.15m without the entrance.

Airflow rate (Q)The air speed was calculated using the average annu-

(fig. 3.34) Cross section of PMC inpatient room to illustrate the gradient of the daylit areaSource: Author

72


al air speed in California. The average annnual wind speed in Escondido is 10.01 mph = 4.47 m /s (refer to appendix C). As previously calculated and mentioned, the area of the window opening is 3.60 m2. Therefore, Q = 0.02 x 3.60 x 4.47 = 0.32 m3 /s

Air change rate (ACH)The air change rate per hour in PMC inpatient room is (Q x 3600)/(area x height) = (0.32 x 3600)/(24x3) = 16 air changes per hour.

3.4.3.3 View; (The health source, 2012)

• All hospital users can enjoy the outdoor terraces that are found on each level and are decked with patio seating and live trees, flowers and shrubs.

• A 1.5 acre green roof provides a scenic and garden view to patients• The leveled site as shown in the site plan (contour lines), is high which pro-

vides a clear view to surrounding hills and valleys and does not allow for any obstructions.

(fig. 3.35) zoning perspectiveSource: (Aia.org, 2014)

73

analytical study

3.4.3.4 Biodiversity & Landscape; (The health source, 2012)

• A 1.5-acre wavy green rooftop is incorporated in the design of the hospital. The roof consists of native vegetation that is planted across the absolute area. This vegetation contributes to energy efficiency since it reduces heat reflec-tance and absorption inside the building and follows the footsteps of the me-dical beliefs that the connection to nature supports in the healing process of patients.

• Throughout the campus, the manifestation of the healing environment is recognised. This includes atriums and garden terraces on every floor for all users to enjoy the natural climate and a walking garden as a relief zone.

• The integration of a vertical garden into the nursing floors.

3.4.3.5 Built Form

• Sand-coloured floors of the hospital’s inpatient rooms gives a sense of nature• The materials chosen for the new Palomar Medical Center are designed to

help reduce noise (PMC facility guide)• Walls of the inpatient rooms are partially cladded with timber which is a na-

tural material and thus, gives a feeling close to nature.

(fig. 3.38) Accessible terraces Source: (Zeit, 2012)

(fig. 3.36) Wavy green roofSource: PMC facility guide

(fig. 3.37) PMC skylight in the wavy green roofSource:(Bestcontracting.com, 2014)

74


(fig. 3.39) Perspective of inpatient ward at PMCSource: (Zeit, 2012)

(fig. 3.40) Descriptive plan of PMC inpatient roomsSource: CO architects presentation

Expansive windows to connect the internal envi-ronment with the external environment

Sand coloured timber flooring

Wall cladded with timber

Nurse pod for obser-vation of inpatient rooms

Light coloured wall

4.10 m

4.10 m

6.1

5 m

7.20

1.0

5 m

75

analytical study

Ele

men

ts o

f B

D1.

i.e

.Q.

1a. d

ayli

ght

Str

ateg

ies

• L

ight

she

lves

•H

> 2

.2m

•A

ligh

t fini

sh to

max

imiz

e th

e re

flect

ion

of

d

aylig

ht

•M

axim

um d

epth

(0.7

6 m

) •M

axim

um s

pan

of (

1.83

m)

PM

C in

pati

ent

ro

om

• D

aylig

ht fa

ctor

(DF)

- O

ptim

um =

3%

• R

oom

dep

th =

2 - 2

.5 x

H(w

indo

w h

ead

heig

ht)

• S

ingl

e-si

ded

Ven

tila

tion

; D =

2.5

h

• S

hadi

ng d

evic

e

D =

10.

0 m

0.61

m3

16 A

CH

• 1.

5 ac

res

wav

y gr

een

roof

pro

vide

s a

gard

en v

iew

to p

atie

nts

• Su

rrou

ndin

g hi

lls a

nd v

alle

ys

Ava

ilabl

e

0.7m

x 2

.4m

and

0.7

m x

2.6

m

Low

-E g

lass

2.4

m

33%

7.15

m a

nd 1

0.0

m

2.73

%

• H

oriz

onta

l ove

rhan

g: S

unsh

ade

wit

h lo

w-E

gla

ss

• M

onso

on lo

uver

s

• O

pera

ble

Jalo

usie

• A

irflo

w R

ate

(Q)

• A

ir c

hang

e ra

te (A

Ch)

• 8

%<

Ove

rall

area

of t

he w

indo

ws<

20%

1b.N

atu

ral

Ven

tila

tion

1c. V

iew

s

• M

any

win

dow

s as

pos

sibl

e sh

ould

look

out

ove

r na

tura

l fea

ture

s

• W

indo

ws

shou

ld b

e ca

refu

lly d

esig

ned

for

the

prov

isio

n of

vie

ws

of n

atur

al, o

utdo

or s

cene

s.

• C

aref

ully

pla

n th

e si

ghtl

ines

and

avo

id e

xter

nal o

bstr

ucti

ons

• If

not

a c

urta

in w

all

then

, w

indo

ws

shou

ld b

e in

the

fol

low

ing

rang

e ;

1m <

Vis

ion

win

dow

hei

ght <

2.2

m

Tab

le 3

.2: R

esu

lts

of P

MC

inp

atie

nt

room

ass

essm

ent

76


PM

C in

pati

ent

ro

om

Ele

men

ts o

f B

DS

trat

egie

s•

Out

door

terr

aces

on

ever

y flo

or•

1.5

acre

s w

avy

gree

n ro

of•

Ver

tica

l gar

den

in n

ursi

ng fl

oor

No

wat

er fe

atur

es in

corp

orat

ed in

the

desi

gn

2. B

iod

iver

sity

&

Lan

dsc

ape

2a. W

ater

Fea

ture

s

3. B

uil

t F

orm

• O

utdo

or n

atur

all a

reas

wut

h ri

ch v

eget

atio

n an

d an

imal

s

• N

ativ

e pl

ants

are

pre

ferr

ed to

sup

port

div

erse

ecc

osys

tem

s

• D

esig

n sh

ould

inco

rpor

ate

the

pres

ence

of p

lant

s in

the

inte

rnal

en

viro

nmen

t and

gar

dens

in th

e ou

tdoo

or e

nvir

onm

ent.

• In

corp

orat

e w

ater

fea

ture

s in

the

bui

lt e

nvir

onm

ent

as w

ater

fe

atur

es h

ave

visu

al a

nd a

cous

tic

bene

fits

• B

iow

all (

exte

rnal

ly o

r in

tern

ally

)

• Pl

ante

r bo

xes

(Ext

erna

lly o

r in

tern

ally

)

• In

ner

cour

t

• G

arde

ns (g

roun

d an

d up

per

floor

s)

• G

reen

roo

d (v

isua

l or

phys

ical

acc

ess)

• So

ft t

one

colo

urs

are

the

mos

t pr

efer

able

to

be u

sed

for

the

colo

urs

of w

alls

. The

se i

nclu

de c

olou

rs s

uch

as y

ello

w, g

reen

or

blu

e.

• Li

ght

tone

s an

d w

arm

col

ours

for

the

floo

ring

col

ours

. The

se

colo

urs

incl

ude

whi

te, c

ream

and

ligh

t gr

ey.

• W

alls

in in

pati

ent r

oom

s ar

e pa

rtia

lly c

ladd

ed w

ith

tim

ber.

•

Sand

col

oure

d ti

mbe

r flo

orin

g to

giv

e a

feel

ing

clos

e to

nat

ure

• C

eilin

g is

whi

te w

hich

allo

ws

light

to

be r

eflec

ted

deep

er i

nto

the

room

77

analytical study

3.5 PMC: Discussion

In the PMC inpatient room the daylight factor was calculated to be 2.2% which does not meet the optimum standard as it was previously mentioned that the optimal daylight factor for inpatient rooms is 3%. However, the addition of light shelves could makeup for the difference.

The room depth should not exceed 2 or 2.5 times the window head height. The-maximum depth allowed according to the rule is 6.5 m. However, the overall room depth is 7.20 m but, excluding the entrance leaves the room with a depth of 6.15 m.

The glazing area is 15 % of the overall room area which fits in the required range of more than 8% and less than 20% of the room area. Since Escondido has a ty-pical Mediterranean climate in which due to its location its summers are warmer than other cities in California and its winters are also cooler than other cities in California, it is preferable that the glazing area would not exceed the required range as summer temperaturs can reach up to an average of 30oC.

As mentioned in chapter 2, the minimum required air speed for naturally venti-lated areas is 0.6m/s and a minimum of 6 ACH is required in inpatient rooms. The table in appendix C was used to calculate the average annual wind speed in Escondido which is 1.10 m/s. After assessing PMC inpatient room it was shown that it experiences an air flow rate of 0.32 m3/s and 16 ACH which means that the airflow rate and the air change rate meet optimal standards.

79

case study

Chapter 4Case Study:Children Oncology Hospital ‘57357’

4.1 Introduction and Scope

This chapter is bisected into questionnaires and analysis of biophilic design el-ements and attributes of both inpatient rooms and chemotherapy ward. At the outset of analysing the chemotherapy ward, questionnaires were first distributed. The questionnaire results were then rated, clarified and displayed in the form of bar graphs. The second part involves the assessment of the chemotherapy ward along with the two inpatient rooms. The results were then exhibited then, com-pared with the analytical examples.

4.2 57357: Children Oncology Hospital, Cairo, Egypt

Soliciting donations for the hospital is not the aim yet, my ideas and credentials go far beyond only providing the hospital with donations. However, I believe that by looking at the history of ‘57357’ and how it was founded, the reason it was founded for and the high curing rates makes it a strong reason for contributing and dedicating the time and help promote and stimulate the development of the hospital through my research. It was intended to assess, evaluate and measure the presence of the selected biophilic design elements and attributes in the case study after understanding the impact of the existence of these elements in health cares on the wellbeing of the users. This assessment was carried through the study model or in other words, the table created with biophilic design guidelines to be retrofitted in health-cares.

80


There was a peak for the time of hardship, where children endured the pain and challenges of cancer for years, arouse the innovative Children’s Oncology Hospi-tal Egypt (COHE) 57357. 57357 stems as a branch of hope and inspiration in our times, dedicated to alleviate the sufferings of Egyptian, Arab and African child-ren. It aims to surpass the challenging frontiers of cure through providing utmost standards of care, moreover, it acts as while being a unique model of charity. Such icon of change and beacon of hope is the reason why 57357 is the case-study of this research. 57357 continues to actively change and meet the challenges and overcome all the obstacles through integrating the newest and best practices in technology, science and management. Thus, this is an attempt to further the re-search, innovation and charitable character that the hospital was built on, to try and adopt biophilic design to help further relieve and better treat child patients.


The 57357 hospital is a success story that portrays the accomplishment and coll-ecticve triumph of the Egyptian society. Such accomplishment was crowned with ‘The Middle East Hospital Build 2010 Prize for Best Physical Environment and Highest Commendation for Best Sustainable Environment.’

(fig 4.1) Perspective of 57357 HospitalSource: (travelreportage.com, 2011)

81

case study

The Hospital is comprised of 180-beds, treatment rooms in Al-Sayeddah Zainab district in Cairo, and is recognized as an internationally well-renowed children’s cancer specialized hospital. It is known to be one of the biggest children‘s cancer hospital in the world. The Hospital is built with Egyptian and internaitional do-nations which initiated in 1998. The hospital opened in 2007, which is a four year delay from the initial target date. The Children’s Cancer Hospital Egypt (CCHP) became named and known as 57357 Hosptial. The numbers reflect the bank ac-count number as a strategy to allow people to better memorise and recall the bank account, in the hope that they would donate money.

4.2.2 Urban context

The hospital is located in Al-Sayeddah Zainab district which as referring to the figure above illustrates the poor context. The selection of the site was not cri-tically chosen since it is surrounded by slum areas that are in bad condition, low income housing, abandoed bone factories. Therefore, the area is heavily

(fig 4.2) 57357 urban contextSource: (Cairobserver.com, 2013)

82


polluted and does not have the qualifications to locate an Oncology hospital or a hospital in gerneral.

4.3 Chemotherapy ward

(fig 4.3) 57357: First floor planSource: 57357 engineering department

(fig 4.4) 57357: Plan of chemotherapy wardSource: 57357 engineering department

(fig 4.5) 57357: Panoramic view of the chemotherapy wardSource: Author

Chemotherapy ward

Open treatment area

5.79

m 7.89

m 10.9

m

5.55 m

D1D2

D3

Nurse station

83

case study

4.3.1 Questionnaire

4.3.1.1 methodology

‘We shape our buildings and afterwards our buildings shape us.’ - Winston Churchill (1943)

The above is a short succinct statement that further explains that the proper functioning of a building results in boosting our lives, communities and cultures. The book of sustainable buildings in practice successfully aimed at advancing the practice of environmentally sustainable buildings. It drew the design of 30 se-lected buildings from 11 different countries and delineated the users’ evaluation of the buildings. Confident, successful decisions about building operations are results achieved through evaluation which offer radical improvements in the way we manage and design a certain building.

‘The main opportunity for further innovation lies in their (building evalua-tion techniques) application.’ (Baird, 2010, p.1)

The design of a scale to rate the data gathered in order to evaluate the hospital was introduced in this book. Such scale assesses the hospital from the perspecti-ve of the user and it followed the methodology used to rate and evaluate several buildings in 11 countries. An example of the techniques used in such investiga-tion includes the distribution of a 60-question questionnaire survey to hospital users and collecting their responses to evaluate different array of factors. Users were given a seven-point scale – seven marking the most ‘satisfactory’ score - to grade several aspects of the building. This was then followed by an analysis of the gathered responses, where a mean value for each variable was calculated on the seven-point scale and also several indices and ratings were computed to create indicators of the overall performance of the building or of particular aspects. Thus, the creation of an odd-numbered scale ensures the existence of a mid-point for a researcher, one that is translated into a neutral grade for the respondents to choose from, thus creating more diversity in the selection – same degree of posi-tive and negative ratings and a neutral rating (Penwarden, 2014).

The steps and procedures of evaluation detailed in the book were implemented in

84


this study. The first visit paid to the hospital involved taking a tour in all parts of the hospital with an architect from the hospital’s engineering department. Subse-quently, a decision was taken regarding the chamber on which the analysis would be carried out. This was followed by determining the population of the chamber and the questionnaire’s sample size. Prior to the execution of the survey, a tho-rough preparation of the survey sheets, along with more visits were performed. Moreover, the survey’s rating methodology similarly follows the same methodo-logy mentioned in the book. This was all implemented in the day-care chamber or what is also called the chemotherapy chamber in the hospital.

Mean, Standard Deviation and the coefficient of variation

The method needed to calculate the mean and standard deviation was gathered from the book of sustainable buildings in practice as well as from a paper written by the AGA center for quality in practice.

MeanThe following equation was used to calculate the mean;

M = Σ(X) / NΣ = Sum ofX = Individual data pointsN = Sample size (number of data points)

Standard Deviation (SD)The standard deviation was calculated using the following formula.

S2 = Σ(X-M)2 / n – 1Σ = Sum ofX = Individual scoreM = Mean of all scoresN = Sample size (number of scores)

Coefficient of variation (CV)The coefficient of variation was calculated using the following formula;

CV = SD / M

85

case study

4.3.1.2 Results

table 4.1

Means, Standard deviation and Coefficient variable of the users´perception scores for each factor they were asked to rate on a 7-point scale

Factor

Daylight

ViewLandscapeWater FeaturesMaterials and colours

sd CvMean

6.50 0.70 1.40

4.50 1.58 0.355.50 0.85 0.151.00 0.00 0.004.60 1.90 0.41

Point scale

a. daylight

Scor

e(%

)

1010

2030

70

50

90

40

80

60

100

2 3 4 5 6 7

The bar graphs display the results of the survey ha-ving each graph comparing the resulty of each ques-tion.

a. daylight

The graph shows the majority rating the daylight in the chemotherapy chamber or daycare with a point 7, 30% a point 6 and 10% and point 5. This might elu-cidate that everyone feels that the chamber is provi-ded with a sufficient amount of daylight. The room is rectangular and some areas maybe daylit more than others due to the different angles of visible sky which is a result of different buildings or obstructions in the opposite side.

b. View

The provided views are very limited or few landscape b. ViewPoint scale

1 2 3 4 5 6 7

Scor

e(%

)

010

2030

70

50

90

40

80

60

100

86


c. LandscapePoint scale

1 2 3 4 5 6 7

Scor

e(%

)

010

2030

70

50

90

40

80

60

100

d. Water FeaturePoint scale

1 2 3 4 5 6 7

Scor

e(%

)

010

2030

70

50

90

40

80

60

100

or trees. Not everyone sitting in the room is capab-le of benefiting from this view. Therefore, the view is not satisfactory to everyone.

This was reflected in the survery where the ratings spread out throughout the scale. Mostly, people that that the view is a 5 (40%). 20% of those who filled the survey thought that it was 6 or 7. The rest thought it was average (4) or below.

c. Landscape

In addition to the patience having limited view, the landscape provided in the hospital is in itself limited. However, the landscape that exists is satisfactory so-mehow.

According to the survey, 90% thought that the lands-cape ranked above average, with 80% rating it 5 and 6. The remaining 10% thought that it was either ave-rage or they had no opinion, being that thez rated it as a 4.

d. Water features

Water features are absent in the hospital. Therefore, 100% ranked it as a 1 on the survey.

e. Materials and colour

Materials and colours used in the hospital is subject to a lot of argument. This is portrayed in the results of the survey as 40% thought that it was average or less than average (1-4) and the rest thought of it as satisfactory, with a maximum of 30% rating it as a 6.

e. Material & ColourPoint scale

1 2 3 4 5 6 7

Scor

e(%

)

010

2030

70

50

90

40

80

60

100

87

case study

4.3.2 57357: Biophilic design elements analysis

4.3.2.1. daylight

Daylight FactorReferring to the daylight factor equation 2.3 in section 2.2.1.9 ‘Daylight Factor’,

• ATotal of all internal surfaces= 2.6(5.06+7.79+1.36+2.93+1.57+0.73+0.83+1.77+2.01+10.38+3.09+38.86+2.68+0.57+1.03+1.82+1+0.3+16.26+4.72+4.72+3.09+2.97+7.96+0.72)+2(3.4x2.6)+2(2.4x2.6)+ (Afloor= 331.9 m2) + (Aceiling= 331.9 m2) =819 m2

• Awindow=92.3 m2

• O1 = 80o and O2 = 40o (The average is used to calculate the DF=60o)

DF =

Source: Author

92.3 * 60 * 0.8

819x 1 = 5.40%

20 m

40o

The blue part indicates the

part in the CTW overlook-

ing at Magra Al-Oyoun fence

leaving an angle of 80o visible

sky

The red part indicates the part of

the CTW overlooking the adjacent

building which is at a distance

of 20 m leaving an

angle of 40o

80o

88


room depthThe window head height in the chemotherapy ward is 2.6m.There are 3 different depths in the ward, D1=5.79m D2=7.89m D3= 10.9m. However, since the maximum depth according to the rule is 2.5 x 2.6 = 6.5 m, D2 and D3 do not abide by the rule and therefore the opposite side to the window does not receive sufficient amount of light.

Glazing area to room areaThe overall area of the ward is 331.9 m2 as cal-culated with 92.3 m2 glazing area. Therefore, (92.3/331.9)100= 27.8 % of glazing area.

4.3.2.2 Natural ventilation

Oncology hospitals require a very critical and cau-tiously design indoor environmental quality. Howev-er, the potentials for having natural ventilation in the hospital is negligible and especially dur to the urban context of the hospital (refer to 4.2.2). Infectio con-trol is implemented all around the hospital, which is a mixed mode system that uses filtered natural air.

4.3.2.3 View

From the chemotherapy ward, the view transmitted is the subtle amount of landscape found in the ground level and also a view to the surround poor areas.

(fig 4.6) 57357: Plan of chemotherapy ward with daylight gradientSource: 57357 engineering department

2.5 m

0 m

5 m

6.5 m7.5 m

10 m

(fig 4.7) Exterior view from CTWSource: Author

89

case study

Tab

le 4

.1: R

esu

lts

of 5

7357

Ch

emot

her

apy

war

d a

sses

smen

t

Ele

men

ts o

f B

D1.

i.e

.Q.

1a. d

ayli

ght

Str

ateg

ies

5735

7 C

tw

• D

aylig

ht fa

ctor

(DF)

- O

ptim

um =

3%

• R

oom

dep

th =

2 - 2

.5 x

H(w

indo

w h

ead

heig

ht)

• S

ingl

e-si

ded

Ven

tila

tion

; D =

2.5

h

• S

hadi

ng d

evic

e

N /

A (I

nfec

tioo

n co

ntro

l)

N /

A (I

nfec

tioo

n co

ntro

l)

N /

A (I

nfec

tioo

n co

ntro

l)

Vie

w o

f lan

dsca

pe fo

und

in th

e gr

ound

floo

r al

ong

wit

h vi

ews

of

the

surr

ound

ing

poor

are

as

N /

A

N /

A

27.8

%

D1=

5.79

m D

2=7.

89m

D3=

10.

9m

5.40

%

No

shad

ing

devi

ces

are

used

apa

rt fr

om th

e st

eel s

truc

ture

s

that

do

not b

lock

an

appr

opri

ate

amou

nt o

f sol

ar r

adia

tion

and

ther

efor

e co

vers

up

mos

t of t

he fa

cade

.

• A

irflo

w R

ate

(Q)

• A

ir c

hang

e ra

te (A

Ch)

• 8

%<

Ove

rall

area

of t

he w

indo

ws<

20%

1b.N

atu

ral

Ven

tila

tion

1c. V

iew

s

• M

any

win

dow

s as

pos

sibl

e sh

ould

look

out

ove

r na

tura

l fea

ture

s

• W

indo

ws

shou

ld b

e ca

refu

lly d

esig

ned

for

the

prov

isio

n of

vie

ws

of n

atur

al, o

utdo

or s

cene

s.

• C

aref

ully

pla

n th

e si

ghtl

ines

and

avo

id e

xter

nal o

bstr

ucti

ons

• If

not

a c

urta

in w

all

then

, w

indo

ws

shou

ld b

e in

the

fol

low

ing

rang

e ;

1 m <

Vis

ion

win

dow

hei

ght <

2.2

m

• L

ight

she

lves

•H

> 2

.2m

•A

ligh

t fini

sh to

max

imiz

e th

e re

flect

ion

of

d

aylig

ht

•M

axim

um d

epth

(0.7

6 m

) •M

axim

um s

pan

of (

1.83

m)

90


Ele

men

ts o

f B

DS

trat

egie

sB

iodi

vers

ity

is n

ot p

rom

oted

at a

ll in

the

site

.

No

wat

er fe

atur

es h

ave

been

add

ed in

tern

ally

nor

ext

erna

lly

Col

umns

foun

d in

the

war

d ea

ch h

ave

a di

ffere

nt c

olou

r. T

he C

TW

is a

n op

en

trea

tmen

t ar

ea w

ith

couc

hes

pla

ced

arou

nd t

he c

ir-

cum

fere

nce

of th

e ro

om.

2. B

iod

iver

sity

&

Lan

dsc

ape

3. W

ater

Fea

ture

s

4. B

uil

t F

orm

• O

utdo

or n

atur

all a

reas

wut

h ri

ch v

eget

atio

n an

d an

imal

s

• N

ativ

e pl

ants

are

pre

ferr

ed to

sup

port

div

erse

ecc

osys

tem

s

• D

esig

n sh

ould

inco

rpor

ate

the

pres

ence

of p

lant

s in

the

inte

rnal

en

viro

nmen

t and

gar

dens

in th

e ou

tdoo

or e

nvir

onm

ent.

• In

corp

orat

e w

ater

fea

ture

s in

the

bui

lt e

nvir

onm

ent

as w

ater

fe

atur

es h

ave

visu

al a

nd a

cous

tic

bene

fits

• B

iow

all (

exte

rnal

ly o

r in

tern

ally

)

• Pl

ante

r bo

xes

(Ext

erna

lly o

r in

tern

ally

)

• In

ner

cour

t

• G

arde

ns (g

roun

d an

d up

per

floor

s)

• G

reen

roo

d (v

isua

l or

phys

ical

acc

ess)

• So

ft t

one

colo

urs

are

the

mos

t pr

efer

able

to

be u

sed

for

the

colo

urs

of w

alls

. The

se i

nclu

de c

olou

rs s

uch

as y

ello

w, g

reen

or

blu

e.

• Li

ght

tone

s an

d w

arm

col

ours

for

the

floo

ring

col

ours

. The

se

colo

urs

incl

ude

whi

te, c

ream

and

ligh

t gr

ey.

5735

7 C

tw

91

case study

4.4 Inpatient rooms

Two inpatient rooms were analysed, one from those in the area overlooking a view (R1) and one from those in the area not overlooking a view (R2) in order to have a comparison on different scales.

(fig 4.8) Typical plan of inpatient roomSource: ´57357´Engineering department

(fig 4.7) 57357: Typical floor planSource: 57357 engineering department

r2

r1

8.32 m

4.84 m 2.30 m 1.18 m

4.19 m

4.88 m

92


4.4.1 57357: Biophilic design elements analysis

4.4.1.1 daylight

Daylight FactorReferring to the daylight factor equation 2.3 in sec-tion 2.2.1.9 ‘Daylight Factor’,

r1• ATotal of all internal surfaces= (8.32x2.6)+(4.88x2.6)+(4.19x2.6)+(1.76x2.6)+(2.30x2.6)+(0.79x2.6)+(0.75x2.6)+(0.36x2.6)+(0.34x2.6)+(1.55x2.6)+ (Afloor= 24.8 m2) +

(Aceiling= 24.8 m2) =115.2 m2

• Aglazing=5.8 m2

DF =

r2• ATotal of all internal surfaces= (8.32x2.6)+(4.88x2.6)+(4.19x2.6)+(1.76x2.6)+(2.30x2.6)+(0.79x2.6)+(0.75x2.6)+(0.36x2.6)+(0.34x2.6)+(1.55x2.6)+ (Afloor= 24.8 m2) +

(Aceiling= 24.8 m2) =115.2 m2

• Aglazing=5.8 m2

DF =

room depthThe window head height in the inpatient room is 2.6m. This means that the maximum depth is 2.5 x 2.6 = 6.5 m. The depth of the total depth of the room is 8.32 m. However, the depth of the room without the entrance is 7.14m and up to the toilet is 4.84 m.

(fig 4.10) Gradient of daylight in R1 and R2Source: ´57357´Engineering department

(fig 4.9) Strip section of R2 with opposite building slightly ending above the middle of glazing partSource: Author

R1 is the room overlooking the view and the Magra Al-Oyoun fence therefore the angle of visible sky was calculated to be 80o

5.8 * 80 * 0.8

115.2x 1 = 3.2%

5.8 * 80 * 0.8

115.2x 1 = 3.2%

2.5 m

0 m

5 m

7.5 m

6.5 m

80o

93

case study

Glazing area to room areaThe overall area of the room is 24.8 m2 as calculated with 5.8 m2 glazing area. Therefore, (5.8/24.8)100= 23.4 %of glazing area.

4.4.1.2 Natural ventilation

As previously mentioned that the infection control is the ventilation system used all over the hospital to ensure a clean environmental quality.

4.4.1.3 View

A very subtle amount of landscape is viewed from the window of R1. Where as there are no view to nature from R2 in addition to a building located in the oppo-site side.

(fig 4.12) View from R2Source: Author

(fig 4.11) View from R1Source: Author

94


Ele

men

ts o

f B

D1.

i.e

.Q.

1a. d

ayli

ght

Str

ateg

ies

• L

ight

she

lves

•H

> 2

.2m

•A

ligh

t fini

sh to

max

imiz

e th

e re

flect

ion

of

d

aylig

ht

•M

axim

um d

epth

(0.7

6 m

) •M

axim

um s

pan

of (

1.83

m)

5735

7 - r

157

357

- r2

• D

aylig

ht fa

ctor

(DF)

- O

ptim

um =

3%

• R

oom

dep

th =

2 - 2

.5 x

H(w

indo

w h

ead

heig

ht)

• S

ingl

e-si

ded

Ven

tila

tion

; D =

2.5

h

• S

hadi

ng d

evic

eIn

tern

al s

hadi

ng d

evic

es a

re

used

: Li

ght c

olou

red

blin

ds

Inte

rnal

sha

ding

dev

ices

are

used

: Li

ght c

olou

red

blin

ds

3.2

%

23.4

%

N /

A

N /

A

N /

A

N /

A

N /

A

N /

A

N /

A

N /

A

N/A

(Inf

ecti

on c

ontr

ol)

N/A

(Inf

ecti

on c

ontr

ol)

N/A

(Inf

ecti

on c

ontr

ol)

N/A

(Inf

ecti

on c

ontr

ol)

N/A

(Inf

ecti

on c

ontr

ol)

N/A

(Inf

ecti

on c

ontr

ol)

Vie

w to

the

gree

nery

and

tree

s

plan

ted

in th

e gr

ound

leve

l.

How

ever

, the

y ar

e no

t cle

arly

seen

by

pati

ent f

rom

bed

posi

tion

No

view

s to

nat

ural

ele

men

ts.

How

ever

, a b

uild

ing

is fo

und

righ

t inf

ront

of t

he r

oom

.

23.4

%

8.32

m a

nd 7

.14

m8.

32 m

and

7.1

4 m

3.2

%

• A

irflo

w R

ate

(Q)

• A

ir c

hang

e ra

te (A

Ch)

• 8

%<

Ove

rall

area

of t

he w

indo

ws<

20%

1b.N

atu

ral

Ven

tila

tion

1c. V

iew

s

• M

any

win

dow

s as

pos

sibl

e sh

ould

look

out

ove

r na

tura

l fea

ture

s

• W

indo

ws

shou

ld b

e ca

refu

lly d

esig

ned

for

the

prov

isio

n of

vie

ws

of n

atur

al, o

utdo

or s

cene

s.

• C

aref

ully

pla

n th

e si

ghtl

ines

and

avo

id e

xter

nal o

bstr

ucti

ons

• If

not

a c

urta

in w

all

then

, w

indo

ws

shou

ld b

e in

the

fol

low

ing

rang

e ;

1m <

Vis

ion

win

dow

hei

ght <

2.2

m

Tab

le 4

.2: R

esu

lts

of 5

7357

inp

atie

nt

room

s a

sses

smen

t

95

case study

Ele

men

ts o

f B

DS

trat

egie

sN

o bi

odiv

ersi

ty h

ave

been

pro

mot

ed i

n th

e en

viro

nmen

t of

the

ho

spit

al .

Nat

ive

plan

ts n

eed

to b

e pl

ante

d.

No

wat

er fe

atur

es a

re fo

und

neit

her

exte

rnal

ly n

or in

tern

ally

2. B

iod

iver

sity

&

Lan

dsc

ape

3. W

ater

Fea

ture

s

4. B

uil

t F

orm

• O

utdo

or n

atur

all a

reas

wut

h ri

ch v

eget

atio

n an

d an

imal

s

• N

ativ

e pl

ants

are

pre

ferr

ed to

sup

port

div

erse

ecc

osys

tem

s

• D

esig

n sh

ould

inco

rpor

ate

the

pres

ence

of p

lant

s in

the

inte

rnal

en

viro

nmen

t and

gar

dens

in th

e ou

tdoo

or e

nvir

onm

ent.

• In

corp

orat

e w

ater

fea

ture

s in

the

bui

lt e

nvir

onm

ent

as w

ater

fe

atur

es h

ave

visu

al a

nd a

cous

tic

bene

fits

• B

iow

all (

exte

rnal

ly o

r in

tern

ally

)

• Pl

ante

r bo

xes

(Ext

erna

lly o

r in

tern

ally

)

• In

ner

cour

t

• G

arde

ns (g

roun

d an

d up

per

floor

s)

• G

reen

roo

d (v

isua

l or

phys

ical

acc

ess)

• So

ft t

one

colo

urs

are

the

mos

t pr

efer

able

to

be u

sed

for

the

colo

urs

of w

alls

. The

se i

nclu

de c

olou

rs s

uch

as y

ello

w, g

reen

or

blu

e.

• Li

ght

tone

s an

d w

arm

col

ours

for

the

floo

ring

col

ours

. The

se

colo

urs

incl

ude

whi

te, c

ream

and

ligh

t gr

ey.

5735

7 - r

157

357

- r2

Cei

lings

are

whi

te in

col

our

and

the

wal

ls a

re p

arti

ally

whi

te a

nd

part

ially

yel

low

97

conclusion and recommendations

Chapter 5Conclusion and Recommendations ‘Biophilia’ was initially used to characterize a psychological orientation. Conse-quently, Biophilic design emerged as a design approach and developed creating a natural-based setting or where the built environment is restricted from inter-fering with natural elements.

The importance of nature has always been acknowledged yet, the technological advancements caused the endless global deterioration. As shown in this research, nature has major positive impacts on the psychological status and well-being of humans. Thus, with the quality of healthcare facilities in general being in con-stant deterioration, a need of introducing biophilic design seemed necessary. an assessment and application was carried out on Egypt as a case study being that it is a densely populated, resourceful developing country with very poor healthcare. After creating a framework with BD guidelines, the contribution to the topic was evaluating and assessing inpatient rooms in international examples that used BD to revalidate the guidelines and destinguish the design guidelines that can be de-duced from biophilic concepts to retrofit in healthcare facilities in Egypt. Subse-quently, therapy and inpatient rooms in the selected case study ‘57357’, Children Oncology Hospital, Cairo, Egypt were assessed using the framework.

KTPH-AC ward KTPH-NV ward PMC inpatient room

2.82 % with light shelves present at a height of 2.4mMax. depth = 7.5 mactual depth=7.15m

34 % 33 %

Max. depth = 7.5 mactual depth=7.15m


15 %

0.32 m3/s

16 ACH

0.61 m3/s

9 ACH

0.61 m3/s

9 ACH

daylight

Factor

room

depth

Glazing

area

Airflow

rate

Airchange

rate

2.73 % with light shelves present at a height of 2.4m

2.2 % with no light shelves

98


View

biodi-

versity

& Land-

scape

water

features

Built

form

• 1.5 acres wavy green roof provides a garden view to patients• Surrounding hills and valleys

• Outdoor terraces on every floor• 1.5 acres wavy green roof• Vertical garden in nursing floor

• Native flower species planted in gardens and around the Yishun pond• Yishun pond is a safe harbour to an array of biodiversity• Meditation garden• Vertical garden

Hospita users benefit from the acoustic and visual benefits of water features found in and around KTPH

No water features

• Yishun pond• Planter boxes outside patient rooms• Court

• Walls in inpatient rooms are partially cladded with timber. • Sand coloured timber flooring to give a feeling close to nature• Ceiling is white

• Floor material is made of timber which gives a feeling close to nature since timber is a natural element• Ceiling and walls are white in colour• Floral patters on the walls

• Floor material is not made of a natural element and is white in colour• Ceiling and walls are white in colour

The table above portrays and compares the assessment results of the inpatient rooms in KTPH and PMC. When comparing the results of the examples ana-lysed, it is clearly manifested in the assessment results that both hospitals abide by most of the rules and design strategies. Moreover, both healthcare facilties comply with the theory of supportive design since the design promotes a natu-ral environment and involvement of physical features that aids and stimulates coping with stress. Moreover, target groups in KTPH and PMC involved not only patients but, visitors and staff as well. Even though both hospitals have certain points where they are likely to improve yet, the design ensured the presence and perfection of basic design features. To conclude, no matter how well planned and well designed the hospital is, it can always have potentials to improve and devel-op.

Going forward to the case study, 57357 the table below represents the assess-

99


ment results of the therapy ward and the two inpatient rooms in 57357.

Since the study assesses the presence of biophilic design elements in the ex-amples and the case study, a comparison and a clear description of most of the results will be illustrated. In the AC ward and the NV ward in KTPH, the daylight factor is 2.82% and 2.73% respectively. Yet, the wards still receive sufficient amount of daylight as light shelves are present. However, In the PMC inpatient room the daylight factor is 2.2% though, the addition of light shelves could make up for the differ-ence. In 57357, the daylight factor in R1 and R2 is 3.2 %. Since Egypt is classi-fied as a hot arid climate, then any increase in the value of daylight factor will have consequences especially if there are no shading devices.

As stated previously, the criteria for daylight factor in inpatient rooms is 3 %. However, rooms with a daylight factor that is significantly less than 3 % are con-sidered to be poorly lit and might be in need of light shelves or artificial lighting. On the other hand, a room that has a daylight factor that is significantly higher than 3 % will result is visual and thermal discomfort especially in hot arid cli-mates like that in Egypt. In this case shading devices will be required to block the unwanted solar heat gain.

Rooms are yellow and white in colourOpen treatment col-ourful ward

Very few and poor landscape in the ground floor which result in uneffective views

No views to land-scape or any natural features

57357 Therapy ward 57357 r1 57357 r2

5.4 %

Max. depth = 6.5 mD1=5.79m,D2=7.89mD3= 10.9m

27.8 % 23.4 %



23.4 %

daylight

Factor

room

depth

Glazing

area

View and

Landscape

Built

form

3.2 % 3.2 %

100


The daylight reaches a maximum depth of 2.5 times the window head height. Exceeding the maximum depth results in having the opposite part of the glazing area poorly lit. Excluding entrance areas in rooms is possible in cases where the depth of the entrance increases the depth of the room and results in disobeying the rule. In KTPH, the overall room depth of both the AC ward and the NV ward is 10m even though the maximum depth according to the rule is 7.5m. However, deducting the depth of the entrance leaves the room with a depth of 7.15m. On the contrary, the room depth has to be considered as 10m since there is an extra bed that requires the area to be adequately lit. However, the light shelves in the wards will compensate for any inadequacy. Furthermore, in PMC the maximum room depth should be 6.5m and also deducting the entrance from the overall room areas leaves the room with a depth of 6.15m instead of 7.20m. Finally, the rooms in 57357 require a maximum depth of 6.5m. After neglecting the entrance and toilet, the room depth is only 4.84m.

It is prerequisite for the glazing area to be in the range of 8% to 20% of the total room area. KTPH wards have a glazing area of 34 and 33 %, PMC 15 % and 57357 inpatient rooms has a glazing area of 23.4%. Overheating, thermal discomfort and sun glare will be the consequence of large glazed areas.

A minimum of 6 air changes per hour is required in naturally ventilated rooms. In PMC the inpatient rooms experience 16 ACH and 9 ACH in KTPH naturally ventilated ward. Therefore, they both abide by the rule. As for the air-conditioned wards in KTPH, substituting the non-operable windows with operable windows would be an ideal solution to benefit from Singapore’s’ weather that is qualified to naturally ventilate spaces as it has a reasonable wind speed.

In PMC the healing environment is clearly manifested and recognised. This in-cludes atriums and garden terraces on every floor for all users to enjoy the natu-ral climate and a walking garden as a relief zone as well as native plants planted in gardens. As for KTPH, include more than 16 landscaped areas and gardens. It includes rooftop gardens, courtyards, and planter boxes outside patient rooms to bring the garden close to patients. The Yishun pond has been involved as a natu-ral extension. The edge of the pond has been planted by native flower species to provide a unique garden experience for the garden users. These plants boost the biodiversity of the area by founding a natural habitat for native fauna. The pond is considered as a safe port for an assortment of biodiversity.

101


Being surrounded with informal settlements and slums, 57357’s healing environ-ment is not apparent. However, the hospital is designed towards modernity in an extreme, useless manner. As a result, they depended on included meaningless steel structures that are meant to somehow act as a shading device. Thus, in or-der to prevent the overheating of rooms, shading devices are necessary. Such flaw in the landscape is nevertheless positively rated when the question-naire was filled in. This is due to the fact that the hospital is evaluated within the context that it is located it. In other words, the surrounding area results in per-ceiving the hospital in an over-rated manner. Whereas if the hospital is assessed in an objective or abstract manner, one would realise the overly poor and limited vegetation that exists, thus negating the importance of patients having a close presence to a natural and highly vegetated environment. This research attempted to further prove the influence of nature and natural elements on patients’ conditions. It reinforces the constant increase in research which have proven that natural elements are in fact fundamentally and directly linked to having positive impact and effect on patients wellbeing. When taking a closer look at 57357, results have showed that some natural features regar-ding patients’ psychological status, healing process and the hospital’s internal environment that are left undefined. Therefore, in order to overcome such flaws, biophilia must be integrated as much as possible in buildings generally, and in hospitals specifically, within both developed and developing countries in order to ensure that developed and successful results that would benefit patients.

103

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109

Appendices

1. How would you rate the daylighting in this chamber on a 7-point scale?

evaluation of the children´s oncology hospital ´57357´on the satisfaction of available natural elements

تقييم املستخدم يف مستشفى األورام لألطفال ’57357‘ عىل رضاهم من العنارص الطبيعية املتوفرة يف

املستشفى

تم تصميم هذا االستبيان لتقييم جودة وفعالية العنارص الطبيعية يف املستشفى وتساعد عىل تحسني حالة

املستشفى لجميع مستخدميها؛ املوظفني واملرىض والزوار. يتم تشكيلها لتقييم املستخدمني عىل أساس

تصورهم ألداء املبنى فيام يتعلق النقاط املذكورة

يرجى ملء هذا االستبيان و الرد عىل جميع األسئلة بدقة وصدق حتى إذا كان يتم تقييم اإلجابات سلبا أو

إيجابا

نرحب كافة االقرتاحات و التعليقات

1. كيف تقيم ضوء النهار يف هذه القاعة عىل مقياس من 1- 7؟

1 2 3 4 5 6 7

This questionnaire is designed to assess the quality and effectiveness of natural elements in the hospital and help improve the condition of the hospital for all its users; staff, patients and visitors. It is formed for the users’ evaluation based on their perception to the performance of the building with regards to the mentioned points.

Users filling this questionnaire are expected to kindly answer all questions precisely and honestly whether the answers are rated positively or negatively.

Suggestions and comments are most welcomed.

Appendix A: A questionnaire for the evaluation of the chemotherapy ward

110


1 2 3 4 5 6 7

2. How would you rate the view to the outdoor environment on a 7-point scale?

3. How would you rate the available landscape elements found in the open spaces or external environment on a 7-point scale?

4. How would you rate the presence of water features found in the hospital, internally and externally on a 7-point scale??

5. In terms of the materials and colours, how would you rate the internal environment on a 7-point scale?

2. كيف تقيم املناظر الطبيعية للبيئة الخارجية عىل مقياس من 1- 7؟

3. كيف تقيم عنارص املناظر الطبيعية املتاحة يف األماكن املفتوحة أو البيئة الخارجيةعىل مقياس من 1- 7؟

4. كيف تقيم وجود عنارص املاء يف املستشفى، داخليا وخارجيا عىل مقياس من 1- 7؟

5. من حيث املواد واأللوان، كيف تقيم البيئة الداخلية عىل مقياس من 1- 7؟

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

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Appendices

Source: E-guide on online weather purchase

Appendix B: Singapore’s average daily wind speen (m/s)

112


Appendix C: Escondido’s average daily wind speen (m/s)

Usa.com, (2010). Escondido, CA Weather.

إقرار

هذه الرسالة مقدمة في جامعة عين شمس وجامعة شوتجارت للحصول على درجة العمران المتكامل والتصميم المستدام. إن العمل الذي تحويه هذه الرسالة قد تم إنجازه بمعرفة الباحث سنة 2014

هذا ويقر الباحث أن العمل المقدم هو خالصة بحثه الشخصي وأنه قد اتبع اإلسلوب العلمي السليم في اإلشارة إلى المواد المؤخوذه من المراجع العلمية كٌل في مكانه في مختلف أجزاء الرسالة..

وهذا إقرار مني بذلك،،،

التوقيع:

الباحث: سارة محمد عبدالمجيد

21/7/ 2014التاريخ:

Biophilic D

esignby (Sara M

ohamed A

bdelMeguid)

(21st July 2014)

المشرفون

د.بكر محمد جمعةمدرس العمارة والتصميم البيئي

الكاديمية العربية للعلوم والتكنولوجيا

أ.د.محمد عبد الكريم صالحيأستاذ التخطيط والتصميم التكامل

جامعة عي شمس

أ.د. خوسيه لويس موروأستاذ العمارة

جامعة شتوتجارت

( يوليو 2014)

التصميم البايوفيلياستراتيجيات التعديل التحديثي للمستشفيات

رسالة مقدمة للحصول على درجة الماجستير في العمران المتكامل والتصميم المستدامإعداد

(سارة محمد عبدالمجيد)

جامعة شتوتجارت جامعة عين شـــــــمس

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