Wards Getting Out of Isolation

<Statement>

Hospital is a place to accommodate people when they are either physically or mentally weak. It helps supporting a stable society.  Under the pressure of shortage of bed spaces in an aging city Hong Kong, the thesis investigates how hospitals exist in this city & the possibilities to expand in this hyper-dense area, to adapt to the medical trend and the fast changing medical technology.

Patients are doubly isolated by the walls of wards and the green belt surrounding the hospitals. They are under high pressure due to lack of connection with the nature and people. However, research proved that patients are less drug-dependent and have more faith in the medical system when they are in a better environment.

With the medical trend of bigger hospitals becoming bigger while smaller hospitals becoming smaller, there starts to have informal services like community doctors visiting patient’s home to have simple treatment.  Instead of having smaller isolated hospital islands within the city, the thesis will explore how architecture can adapt to this new trend, to provide connection to the society for a better hospitalization environment for the patients.

<The Need of Hong Kong>

Hong Kong is suffering from shortage of bed spaces at the moment, and the demands will be even imperative in ten years, only around 300 bed spaces are planned to be built while 2860 bed spaces are still under supply.

<Hospitals in the city>

There are different scales of public and private hospitals, serving for area of different population density in Hong Kong.

To know more about how hospitals exist in urban fabric, I have drawn some comparison between large and small-scaled public and private hospitals in dense and not dense area. General hospitals are chosen, showing surroundings within 1km diameter.

For the public hospitals, there are green belts insulating them from other parts of urban fabric. This is related to the guidelines of having insulation from noises & fumes of main road and industrial area. However, private hospitals are not following this guideline.

<Public & Private Hospitals>

Public and private hospitals have different financial composition. 95% of budget is sponsored by government for public hospitals. However, for private hospitals, most of the budgets are paid by patients. It shows that having green belt have no commercial value to private hospitals, to provide a better environment for patients. Hospitals are isolated like an island in the city.

<A Patient’s Journey>

A patient’s journey is studied. This patient is suffered from fever and being sent to the Queen Elizabeth hospital in Jordon. He lived in the hospital for 4 days. Except the first day of being diagnosed in the A&E department and did a body check in the X-ray department, he spent almost all his time staying in his ward. Nurses and doctor come to him to do treatment and have checks with him instead of he going out.

The patient is doubly isolated from outside environment, not only from the wall of ward, also from the green belt of hospital.

Except the patients who need acute care like isolated units and intensive care units, for more than 60% of patients, just as the case above, only close observation by medical staff and simple treatment is needed.
<The need of connection>

Roslyn, Lindeim a hospital design expert claimed that patients are subjected to high level of stress because of “in some way out of connection” and lack meaningful social and natural connectedness.

Hospitals’ design has been over focused on efficiency of nurse rather than efficiency of patients’ healing. The thesis should explore the possibilities of connecting wards to the city rather than continue building isolated island in the city.

<HK medical trend>

With the medical trend of bigger hospitals becoming bigger while smaller hospitals becoming smaller, Hong Kong medical system is also showing the change for this new trend.

As the government wants to develop the acute hospitals, the cost of acute facilities has been rising. While having limited bed spaces, the government is reducing hospitalization to reduce the cost and space needed. There have been recently community doctors and nurses visiting patient’s home after the patients being sent back from hospital, old aged home, or clinic.  I think architecture may have a role in this uprising trend when smaller hospitals are starting to dissolve to the community.

<Proposal>

Different from the existing model of double isolation for hospital in the city, I suggest taking out the wards from the hospitals. While letting the acute facilities to grow with more spaces and in a larger scale, smaller hospitals can exist in a scale of a ward/ bed space, having different peculiar relationship with the city fabric.

<Site>

With the study of percentage of aging population, chai wan is selected, for its highest proportion of people aged 65 years old by 2020, also for its eastern hospital, which is one of the largest scaled hospitals in Hong Kong.

<Comments in 1st Jury>

Mr. David Erdman:
-The architectural preposition should be clearer, instead of just a sociological thesis.
-Not sure about atomizing hospital is a right way. The project should avoid being a product design project, also interior fitting out project instead of an architectural thesis. There could be possibilities of a prefabricated room to reconstitute a room to fit in the use of hospitalization.
-Should look more in the private hospitals, how they compensate about not having a green belt, for example looking at their windows, façade. They also provide hotel like & lifestyle like environment.

Dr. Jia Beisi:
-There is missing information of how medical experts foresee about the future of hospitals (bigger hospitals become bigger while smaller hospitals become smaller).
-There is possibility of reusing buildings, to transform them to fit in technical and circulation needs of a hospital. That maybe a system, panel system and wall system to transform building to receive different services. The façade maybe a point to design to create peculiar relationships with the community. Architecture is becoming less and less physical, while more about urban network, system and services. You are looking at extreme flexibility.
-More case studies should be looked at
-Nice Diagrams

Mr. David Erdman:
-One of the Case studies can be Richards Medical Center by Louis I Kahn. There could be case analysis on how they balance their ventilation and the interior environment in their lab.

<Bibliography>

Hospitals in the city:
-Hong Kong Hospital Authority, available at http://www.ha.org.hk/visitor/ha_index.asp
-Town Planning Guidelines, Town Planning Board, available at http://www.info.gov.hk/tpb/
-Hong Kong Planning Standards & Guidelines, Planning Department, available at http://www.pland.gov.hk/

Public vs Private:
-My health my choice by Food and Health Bureau HK government, available at http://www.myhealthmychoice.gov.hk/pdf/appendixC_chn.pdf

A Patient Journey, Hong Kong medical system:
Thanks my nurse friend, Johnny Lam, for providing the information

Site Study:
-Hospital Authority Annual Plan 2013-2014, available at http://www.ha.org.hk/upload/publication_12/451.pdf