Redefining Healthcare Facilities

Project: Healthcare Facilities at Lucknow and Delhi/NCR

Architects: RSMS Architects Pvt Ltd, New Delhi

The evolution of healthcare in India over the past 25 years has been quite metamorphic. The industry is shifting to a value-based service model, where outcomes and satisfaction drives reimbursements and the patient experience is taking on a whole new level of importance for providers who are looking to add value by designing more patient and family- friendly spaces.

Despite the fact that India has far lesser number of beds available for population when compared with WHO recommendations, yet healthcare in India remains inaccessible and unaffordable by majority of the population. The Government of India in its recent National Health Policy has provided thrust on three things to overcome some of the challenges faced by the healthcare industry: Increased investment, by way of spending approximately 2.5% of GDP; Providing policy support– the ambitious ‘Ayushman Bharat/Modicare’ to bring accessibility and affordability to approximately 40% of India’s population; and attractive opportunities– government has a lot of physical infrastructure available in district hospitals (specially in smaller towns) but it remains underutilized owing to manpower and lack of state-of-the-art medical technology. PPP initiative may act as a boon.

As a result, the private healthcare providers are likely to face the challenge of providing quality medical care to such a large section of population. So all these factors put together, not only do we have a huge growth potential but also puts us in a place where the service providers and architects together will have to find new ways to cut costs if they want to take advantage of NHP and Ayushman Bharat.

Over the span of two decades of healthcare planning, the architects believe that a hospital is a dynamic space, and hence shall be designed to be flexible enough to sustain the forthcoming changes whether it’s in the form of government policies or technological advancement or changes in municipal regulations. Through our recent projects below we will demonstrate how RSMS as healthcare planners have utilized these opportunities.

APOLLO-MEDICS SUPER SPECIALTY HOSPITAL, LUCKNOW
Built over a sprawling 3,30,000sq ft area, it’sa 330-bedded quaternary care hospital with state-of-the-art modern healthcare facilities with the aim to provide specialized medical care across 10 centres of excellence and more than 30 specialties spearheaded by internationally trained doctors.

The architects realized that the construction and running a large facility like this requires considerable amount of energy and resources as hospitals are energy guzzlers running 24x7x365, and some of the areas remain mechanically operational even if the spaces aren’t occupied. Therefore, a sustainable approach was adopted to healthcare design, whether it’s the building orientation and positioning to achieve maximum day-lighting or use of renewable materials with lower VOC, or preservation of water or recycling of scrap materials or utilizing sustainable technology, renewable resources like solar, wind, etc, the architects explored and incorporated all the possible means of achieving sustainability. Apollo-medics became the first LEED Gold certified private hospital in Uttar Pradesh.

The surrounding potential areas of the site such as nature trails and wetlands were identified and planned accordingly to take advantage of those in creating healing environment. The hospital is located on VIP Road, adjacent to beautiful parks and green spaces. The design aimed to create a building with a unique architectural language that would complement the surrounding landscape, as well as provide excellent views to the users.

Thus, the curvilinear form of the hospital is an attempt to gather the range of views on the eastern side of the site from the patient areas. The planning also makes use of maximum daylight in the building especially in-patient rooms, intensive care rooms and circulation areas along with an attempt to bring light into the basements by using courtyards and light wells, without compromising on fundamentals which are essential to healthcare planning.

Hospitals can be very intimidating to the users, and hence the design intent was to create a clear and definable circulation system to facilitate way-finding and to provide a pleasing infrastructure and ambience for staff and visitors. The lighting systems were also critically analyzed and designed, especially night lighting by way of strategically placing signages in order to make the environment less intimidating. Following a ‘salutogenic and biophilic design as therapeutic approaches to sustainable architecture’, the architects efficiently designed curative spaces and built spaces which seamlessly integrated the green pockets within and outside the medical building blurring the boundaries of exterior
and interiors.

Hybrid Patient Room Design: The presence of family and friends close during recovery can make a dramatic difference, and this concept has encouraged the care providers to go for hybrid patient rooms where things like sofa-beds and recliners and other convertible furniture can go a long way to ensure that visitors have the required space without crowding the room and simultaneously providing more personalized space which reduces anxiety while enhancing satisfaction. The facility is designed to be more hospitable, offering warmer colour palettes, artwork and larger fenestrations to allow for more natural light and create vistas to the adjacent community parks.

RADIANCE WELLNESS CENTRE

Over the years we have seen that the wellness programmes are becoming very prevalent in our society owing to the rising concerns related to lifestyle diseases and societal changes. This has led to a lateral shift towards wellness and preventive healthcare. At Radiance Clinic, the architects ensured that the space doesn’t lose its character and purpose. To liberate patients, a variety of seating options were designed such as a cluster of chairs around a coffee table for families, a quiet space for professionals and child-friendly corners, etc. The treatment areas were blended with natural views and natural lights that not only create the sense of calmness among the patients but also work as a positive distraction, thus changing trends in healthcare facilities; enlightening spaces which work more to give a feel of ‘an experience centre’ rather than mundane dull looking diagnostics and treatment space– a kind of ‘boutique faclity’.

RAJIV GANDHI CANCER INSTITUTE AND RESEARCH CENTRE, DELHI
Awarded as the Best Healthcare Facility Design at the Global Health Zenith Confluence 2019 (Medical Infrastructure Planning Summit), and recognized as one of the most Safe and Secure Hospitals in India at FIST Awards, 2020; The Rajiv Gandhi Cancer Institute and Research Centre emerged as a 550 bedded oncology super speciality hospital located in Sector 5, Rohini Institutional Area in North-West Delhi.

The 600000sq ft project is as per the ‘best international design practices’. The institute has complete spectrum of oncology clinical specialties which cover all modes of treatment including surgeries, medicines, radiation therapy, bone marrow transplant, etc, redefining benchmark for healthcare facilities.

The architects faced the challenge of expanding a hospital at Delhi but with the expansions of hospital came the challenge of expansion of support and services areas as well within the limited piece of land and with an ongoing existing facility of 250 beds. The whole idea was to consider the existing facilities, identify the additional facilities required for the expansion up to 550 beds and integrate the existing as well as proposed facility into a single hospital unit. With the additional FSI under TOD policy, the master- planning was done with the aim of unlocking the potential of the land for the additional FSI but also for the likelihood of any further increase in future (thus future-proofing the design) and at the same time flexible enough to cater the present.

The process of developing the design concepts for RGCI required the design team
to attain a deep understanding of the working of RGCIRC. This was very important as the redevelopment and expansion is set to happen in and around a fully functional healthcare facility without any disruption which required meticulous planning for each stage of work.

The facility is connected and served by a thoughtfully designed road network with strategically planned access points. The emergency and main entrance drop-off points were kept near the entrance gate. Clear and prominent signages were installed to lead the visitors to the entrance drop-offs as well as the automatic MLCP.  The emergency entrance was kept free from the main entrance to avoid any possible traffic obstructions. A separate entry/exit was provided from the west side for service and utility vehicles.

Automatic-MLCP Block: In order to unlock the potential of the site, fully automatic MLCP building was proposed with 486 cars with future provision of additional 185 cars planned within 16 floors. The MLCP building was placed to the rear of the site, thus negating the visual prominence of the structure. However, access to the MLCP was kept simple and direct.

Utility Block (Energy Centre): The main utilities like the electrical sub-station, pump rooms, boiler rooms and electrical panel rooms were planned at the rear of the facility away from public access and public vision. The location also allows for easy access to and from the service entrance.

Intensive Care Units: Apart from quality of care, the healthcare experience is also defined by the amount of time a patient spends in a hospital; the lesser the time, the better is the experience. This further ensures that the same infrastructure can be used to treat more and more patients. In order to achieve the same, the ICU was designed in a way that every bed gets optimum amount of natural light along with the view of outside thus reducing the risk of ICU psychosis at the same time ensuring a faster recovery and thus an attempt to contribute to reduce the average length of patient stay. The location of the nurse stations were strategically planned in order to ensure maximum vision, better monitoring and to increase the efficiency of care providers.

Out-Patient Department (OPD) Basis Multi Specialty Group (MSG) Concept: Understanding the level of depression, anxiety and fear a patient goes through when he visits a cancer hospital for the first time, the architects didn’t want to increase the panic situation by making the patient travel within the hospital for right consultation.

Therefore, OPD with MSG concept was introduced at RGCI where various types
of medical specialty care such as medical, surgical and radiation oncology is provided within one specialty department. The patient remains in one examination room and all the required consultation is provided at one point instead of the patient shifting between various consultations chambers, till the desired protocol of treatment is established.

FACTFILE

Client: RGCI, Apollo-medics, Radiance

Design team: Manu Malhotra, H.S Sandhu, Rajeev Bhumbuck, Hariom Sharma, Karthik Srikrishna, Vineet Jangid, Isha Goswami, Kumar Avinash

Consultants: Arun Uttarwar & Associates (Structural); ABL Hospitech Pvt Ltd (MEP)

Contractor: RGCIRC: VRC (Civil, MEP & F); Apollo-medics Super Speciality Hospital: SCG (Civil), Martinet Engineers (Electrical), Zamil (HVAC); Radiance Wellness Centre: Safi Interiors Pvt Ltd

Built-up area: RGCIRC: 6,00,000sq ft; Apollo-medics

Super Speciality Hospital: 3,30,000sq ft; Radiance Wellness Centre: 2500sq ft

Year of completion: RGCIRC: 2019; Apollo-medics Super Speciality Hospital: 2019; Radiance Wellness Centre: 2020