Health Care Facilities Hospitals Report on Training Visit

Home , Coronary care unit, Field hospital, Hospital train, Intensive care unit, Maternity hospital, Polyclinics in England

SLOVAK UNIVERSITY OF TECHNOLOGY IN BRATISLAVA FACULTY OF ARCHITECTURE INSTITUTE OF HOUSING AND CIVIC STRUCTURES

HEALTH CARE FACILITIES HOSPITALS REPORT ON TRAINING VISIT

In the frame work of the project

No. SAMRS 2010/12/10

“Development of human resource capacity of Kabul polytechnic university”

Funded by

UÜtà|áÄtät ECDC cÜÉA Wtâw f{t{ YtÜâÖ

December, 14, 2010

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Acknowledgement:

I Daud Shah Faruq professor of Kabul Poly Technic University The author of this article would like to express my appreciation for the Scientific Training Program to the Faculty of Architecture of the Slovak University of Technology and Slovak Aid program for financial support of this project. I would like to say my hearth thanks to Professor Arch. Mrs. Veronika Katradyova PhD, and professor Arch. Mr. stanislav majcher for their guidance and assistance during the all time of my training visit. My thank belongs also to Ing. Juma Haydary, PhD. the coordinator of the project SMARS/2010/10/01 in the frame work of which my visit was realized.

Besides of this I would like to appreciate all professors and personnel of the faculty of Architecture for their good behaves and hospitality.

Best regards cÜÉyA Wtâw ft{t{ YtÜâÖ

December, 14, 2010

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

VISITING REPORT

FROM

FACULTY OF ARCHITECTURE

SLOVAK UNIVERSITY OF TECHNOLOGY

IN BRATISLAVA

This visit was organized for exchanging knowledge views and advices between us (professor of Kabul Poly Technic University and professors of this faculty).

My visit was especially organized to the departments of Public Buildings and Interior design.

From Institute of interior design Mrs. MSc. Veronika Kotradyova, PhD and from Institute of Public Buildings Mr. Ing. arch. Stanislov Majcher, PhD. They were responsible for my activities.

I organized my activities in four parts as below:

1. Pedagogic Activities 2. Research Activities 3. Practical activities 4. Excurse activities

Each part is described as following:

1. PEDAGOGIC ACTIVITIES:

I attended to the lectures of the professors and, saw the methods of their lectures and teachings; I also visited the classes and saw the students and their activities.

Besides of these, I also participated to the conferences and seminars, presented by the professors and students. One seminar was presented by an Italian Professor Jader Tolja who was invited from Italy. His presentation was about (Affects of architectural elements and designs on Human Nervous System). It was very good and useful presentation, he described some affects of the architectural elements and designs on human nervous system and practically proved that architecture has very direct affects on nervous system of the human, if the design is a success design and acceptable, its affect is good and you feel well and comfort but if the design is not a success and acceptable

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

design so you don’t feel well and comfortable, this will affect very bad and insufferable on your nervous system and even sometimes cause some mental problems.

Professor PHD Mrs. Veronika during presenting the lecture

Students are listening to the lecture at class

I also had a look from the studios of architecture in this faculty. In these studios they were working on their projects and modules of their projects. The students have to design one project in each semester. These projects are included all necessary plans, elevations, sections, details and modules. They make these modules from carton, wood and other special materials which are available very easily.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Students are listening to the lecture at class

Students in architectural studio consulting with their Professors about their sketches

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Module of a projects made by the 3rd class students

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Module of a projects made by the 3rd class students

Module of a stair projects made by the 3rd class students

2. RESEARCHE ACTIVITIES:

I researched about HealthCare Facilities (Hospitals) and its history, classifications and designs in Islamic countries and Europe.

I studied some books which were given to me by the professors, and searched at the library and used some books, besides of them I searched in the internet too. During this period I prepared a knowledgical article which the brief information about it is as below, and the whole article is prepared in a separate file and it is also attached:

HEALTH CARE FACILITIES

OVERVIEW

Health care facilities encompass a wide range of types, from small and relatively simple medical clinics to large, complex, and costly, teaching and research hospitals. Large hospitals centers may include all the various subsidiary health care types that are often independent facilities.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

CLASSIFICATION

A trend towards specialization has resulted in a growing number of health care types. Among them are hospitals, nursing homes, outpatient facilities, psychiatric facilities, rehabilitation facilities, hospices, assisted living facilities, congregate housing, adult day care facilities, and various specialized outpatient facilities. These facilities currently include sections on the following four specific building types:

A. Hospitals B. Nursing Homes C. Outpatient Clinic, including the specialized diagnostic and treatment areas which may be stand-alone facilities D. Psychiatric Facility, including psychiatric hospitals

Subcategories

These categories have the following subcategories:

• Abortion clinic • Adult daycare center • Ambulatory surgery center • Clinics • Convenient care clinics • Doctor's offices • Free clinics • Hospitals • Hospital ship • Hospital train • Inpatient care • Isolation ward (medicine) • Nurse-led clinics • Nurse-managed health centers

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

• Polyclinics • Sanatoriums • Sanyukai • Sick bay • Surgicenters • Urgent care

• Abortion clinic

An abortion clinic is a medical facility that primarily performs or specializes in abortions. Such clinics may be public medical centers or private medical practices.

• Adult daycare center

An adult day care center, also commonly known as adult day services, is a non-residential facility providing activities for elderly and/or handicapped individuals. Most centers operate 10 - 12 hours per day and provide meals, social/recreational outings, and general supervision. Adult daycare centers operate under a social model and/or a health care model.

• Ambulatory surgery center

Ambulatory surgery centers (ASC) are also known as outpatient surgery centers or same day surgery centers. Medical facilities where surgical procedures not requiring an overnight hospital stay are performed are sometimes called surgicenters. Such surgery is commonly less complicated than that requiring hospitalization. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care.

• Clinics

A clinic (or an outpatient clinic) is a small private or public health facility that is devoted to the care of outpatients, often in a community, in contrast to larger hospitals, which also treat inpatients. Some grow to be institutions as large as major hospitals, whilst retaining the name clinic. These are often associated with a hospital or medical school.

• Convenient care clinic

Convenient care clinics (CCCs) are health care clinics located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses and provide preventative health care services. They are sometimes called "retail clinics", “retail-based clinics” or "walk-in medical clinics." CCCs are usually staffed by nurse practitioners (NPs) or physician assistants (PAs). Some CCCs, however, are staffed by physicians.

• Doctor's office

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

A doctor's office is a suite of rooms where a physician receives and treats patients, and otherwise practices medicine. When patients first arrive at a doctor's office, they normally check in and wait in a waiting area until called in to be examined in the examination room.

• Free clinics

• Hospitals

A hospital, in the modern sense of the word, is an institution for health care providing patient treatment by specialized staff and equipment, and often, but not always providing for longer- term patient stays. Its historical meaning, until relatively recent times, was "a place of hospitality" During the Middle Ages hospitals served different functions to modern institutions, being almshouses for the poor, hostels for pilgrims, or hospital schools. The word hospital comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality that is the relation between guest and shelterer, hospitality, friendliness, hospitable reception. Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for several days or weeks or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others often are described as clinics.

Norfolk and Norwich University Hospital in the East of England

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

All India Institute of Medical Sciences in Delhi, India

The best-known types of hospital are the general hospital, teaching hospitals and clinical hospitals. The general hospital is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health. A general hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals have their own ambulance service

A teaching hospital in Canada

Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems, certain disease categories, and so forth. A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth- century origins began as one building and evolved into campuses.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school, nursing school or university.

A small hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services. Worldwide, most hospitals are run on a nonprofit basis by governments or charities.

They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as cardiology or coronary care unit, intensive care unit, neurology, cancer center, and obstetrics and gynecology and etc.

Some hospitals will have outpatient departments and some will have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.

Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments and/or release of information departments

• Hospital ship

A hospital ship is a ship designated for primary function as a medical treatment facility or hospital; most are operated by the military forces or navies of various countries around the world, as they are intended to be used in or near war zones. Firing on a hospital ship is a war crime. Some hospital ships, such as the SS Hope, belong to civilian agencies, and as such are not part of any navy.

A hospital ship

• Hospital train

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

A hospital train is a railway train with carriages equipped for the provision of healthcare. Historically this has ranged from trains equipped to transport wounded soldiers, with basic nursing and first aid facilities on board, to fully equipped mobile medical centers, sometimes including operating theatres and nursing wards.

A train-based mobile medical center

of Russian Railways

• Inpatient care

Inpatient care is the care of patients whose condition requires hospitalization. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill, have had an accident or severe trauma.

Inpatient care goes back to 230 AD in India where Ashoka the Great founded 18 hospitals. The Romans also adopted the concept of inpatient care by building a specialized temple for sick patients in 291 AD on the island of Tiber.

The original model for inpatient care required a family physician to admit a patient and then make rounds and manage the patient's care during their hospital stay. That model is rapidly being replaced by hospitalist medicine a term first used by Dr. Robert Wachter in an article written for the New England Journal of Medicine in 1996.

The concept of hospitalist medicine provides around the clock inpatient care from physicians whose sole practice is the hospital itself. They work with the community of primary care

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

physicians to provide inpatient care and transition patients back to the care of their primary care provider upon discharge. Using this approach, primary care physicians are no longer required to make rounds or be on call.

Today, hospitalist medicine is the fastest growing segment of medicine and is being adopted by hospitals worldwide for inpatient care.

• Isolation ward (medicine)

In hospitals and other medical facilities, an isolation ward is a separate ward used to isolate patients suffering from infectious diseases. Several wards for individual patients are usually placed together in an isolation unit.

In an isolation unit, several measures must be implemented in order to reduce the spread of infection. The units are generally placed away from the main hospital, and staff often only works in that unit. In some hospitals, the unit is placed in a separate building. Ventilation is important to reduce the transmission of airborne spores, and the most severely affected patients are placed in separate wards. However, in some circumstances, especially in areas experiencing a major epidemic, makeshift isolation wards can be constructed.

Isolation wards are used to isolate patients who pose a risk of passing a potentially harmful infection on to others. Such infections can range in severity widely, from diseases such as influenza to ebola, although more precautions are generally taken with diseases of a higher mortality rate. Outside major hospitals, isolation wards can be set up to control infection in crowded places, or those lacking substantial medical facilities. Many major passenger ships contain separate wards which can be converted for use in isolating patients.

• Nurse-led clinic

A nurse-led clinic can be considered an umbrella term which describes any outpatient clinic that is run or managed by Registered Nurses, Nurse Practitioners or other nursing professionals. Nurse-led clinics have assumed distinct roles over the years, and examples exist within hospital outpatient departments, public health clinics and independent practice environments.

A broad definition of a nurse-led clinic defines these clinics based on what nursing activities are performed at the site. Nurses within a nurse-led clinic assume their own patient case- loads, provide an educative role to patients to promote health, provide psychological support, monitor the patient's condition and perform nursing interventions. Advanced practice nurses and nurse practitioners may have expanded roles within these clinics, depending on the scope of practice defined by their state, provincial or territorial government.

The recent growth of nurse-led clinics is considered an emerging area of nursing practice; they were originally discussed in nursing journals in the 1980s, and developed over the 1990s into practice areas that have generated financial, legal and professional challenges over the years. There has been recent growth of nurse-led clinics both within hospitals and in the community. However, that growth has been unequal across different legislative regions. Nurse-led clinics typically focus on chronic disease management: conditions where regular

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

follow-up and expertise is required, but also where a patient may not necessarily need to see a physician at every visit. Most nurse-led clinics use nursing theory and knowledge to educate patients and form care plans to manage their conditions.

Many nurse-led clinics have also been associated with enhanced patient satisfaction with care. A nurse-led clinic for intractable constipation in pediatric populations was compared to a pediatric gastroenterology clinic, illustrating that parent satisfaction was significantly higher for those who attended the nurse-led clinic.

In areas where nursing practice may require additional support to maintain patient safety, some nurse-led clinics have implemented decision support tools, computerized systems and evidence-based algorithms to support their practice. Nurse-led clinics which utilize computerized decision support tools to manage oral anticoagulation dosages were found be to as effective as hospital-based clinics for INR control and stability.

• Nurse-managed health center

A nurse-managed health center provides health care services in medically underserved rural and urban area. In some countries where there is limited access to health care. Nurse- managed health centers provide health care to uninsured and underinsured people. Nurse- managed health centers are usually affiliated with nursing schools, universities, and/or independent non-profit organizations. Managed by advanced practice nurses, nurse-managed health centers provide health care to vulnerable communities using a nursing model.

The first nurse-managed health centers was created at Arizona State University over 25 years ago, and it is still in existence today.

Nurse-managed health centers serve populations that are demographically similar to those served by Federally Qualified Health Centers (FQHCs). In some cases, Nurse-Managed Health Centers are FQHCs. Nurse-Managed Health Centers tend to be located in or near low- income communities. Over half of the patients seen at Nurse-Managed Health Centers are females who come from racial/ethnic minority populations and are likely to have experienced health disparities. Nurse-Managed Health Centers are managed and staffed by advanced practice nurses, including nurse practitioners. In some Nurse-Managed Health Centers, nurses collaborate with physicians to provide care. In other Nurse-Managed Health Centers, nurses work independently.

Many Nurse-Managed Health Centers provide a full range of primary care services, comparable to services provided by primary care physicians. Some Nurse-Managed Health Centers also provide behavioral health services, including family and couples therapy. In addition, all Nurse-Managed Health Centers provide health promotion, wellness, and disease management services.

Nurse-Managed Health Centers also focus on preventive health care, especially regarding certain chronic conditions like asthma, hypertension, diabetes, and obesity. This focus on preventative, holistic health care has been shown to reduce emergency room usage and decrease the length of hospital stays among Nurse-Managed Health Center patients.

• Polyclinic

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

A polyclinic is a place where a wide range of health care services (including diagnostics) can be obtained without the need for an overnight stay. Polyclinics are sometimes co-located with a hospital.

A typical polyclinic houses general medical practitioners such as doctors and nurses to provide ambulatory care and some acute care services but lacks the major surgical and pre- and post operative care facilities commonly associated with hospitals.

Generalised health centres and health clinics offering a mix of community based health care services have existed in England since the early years of the National Health Service (NHS) They have typically provided specialist care such as ophthalmology, podiatry, dentistry, minor injuries nursing, and therefore provided services that fell between that of the GP service and those available at the hospital.

Some primary care trusts in England have attempted to bring together even more services into such centres, most notably by co-locating GPs, health laboratories, pharmacies and other services under one roof. The Heart of Hounslow Centre for Health for example has GP services, outpatient care, physiotherapy, dentistry, podiatry, social care outreach, mental health services for children and a gym to help in rehabilitation. All these services take place in a purpose-built facility. However, the centre does not provide urgent care and only has a limited range of diagnostics.

• Sanatorium

A sanatorium (also spelled sanitorium and sanitarium) is a medical facility for long-term illness, most typically associated with treatment of tuberculosis (TB) before antibiotics. A distinction is sometimes made between "sanitarium" (a kind of health resort, as in the Battle Creek Sanitarium) and "sanatorium" (a hospital).

The rationale for sanatoria was that before antibiotic treatments existed, a regimen of rest and good nutrition offered the best chance that the sufferer's immune system would "wall off" pockets of pulmonary tuberculosis (TB) infection. In 1863, Hermann Brehmer opened the Brehmerschen Heilanstalt für Lungenkranke in Görbersdorf (Sokołowsko), Silesia (now Poland), for the treatment of tuberculosis. Patients were exposed to plentiful amounts of high altitude, fresh air, and good nutrition. Tuberculosis sanatoria became common throughout Europe from the late 19th century onwards. The Adirondack Cottage Sanitarium, established in Saranac Lake, New York, in 1885, was the first such establishment in North America. According to the Saskatchewan Lung Association, when the National Anti-Tuberculosis Association (Canada) was founded in 1904, its members believed that a distinction should be made between the health resorts with which people were familiar and the new tuberculosis treatment hospitals: "So they decided to use a new word which instead of being derived from the Latin noun sanitas, meaning health, would emphasize the need for scientific healing or treatment. Accordingly, they took the Latin verb root sano, meaning to heal, and adopted the new word sanatorium."

• Sanyukai

Sanyukai Nonprofit Organization, Incorporated is an official nonprofit organization dedicated to the aid of the homeless population in Tokyo, Japan. Sanyukai includes a free

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

clinic, as well as an outreach program which distributes food and clothing to the homeless in the area.

Sanyukai states in their pamphlet: "It is the hope of Sanyukai that the suffering may be comforted, healed an enabled to stand on their own." The organization functions on several levels, which work together in an effort to give the homeless population the tools they need to stay healthy and become self-supporting.

Sanyukai is located in the Sanya district in Tokyo, Japan. The building has three floors, and includes the free Sanyu clinic, a kitchen where food is prepared for the Outreach Program and an office where free professional Legal Advice is offered. Sanyukai also hosts events in an effort to bring the community together in aiding the homeless.

Sanyu clinic

Located on the first floor of the Sanyukai building, Sanyu Clinic is one of the only free clinics in all of Tokyo. Here is where homeless members of society can receive consultations with professional doctors and nurses. Depending on the diagnosis, the patient may receive medical advice, free prescription medication, or a ride to the hospital for intensive care. Most of the clinic staff are medical professionals volunteering on their time off. At this point, Sanyu clinic hosts 9 doctors, 1 chiropractor, 4 acupuncturists and 6 nurses. Working full time at Sanyukai is one registered nurse who is also the clinic coordinator. Another nurse works part-time.

Another aspect of Sanyukai is how it functions as a gathering place for the homeless in the area. Everyday, a large group of people can be found in front of the building, joking and socializing. Most of the homeless people in the area are middle aged or elderly men who are out of work and have no real family. Sanyukai functions as a place where these people can relax and socialize. The volunteers provide green tea and other basic things at the Sanyukai entrance that help these people on a daily basis. The homeless are provided with toothbrushes, shaving razors, towels, hand soap and laundry detergent, to help them maintain their hygiene and health. Once a month a barber volunteers his services and spends a day giving as many free haircuts as he can. Overall, Sanyukai is not only a place where the homeless go when they are sick or starving, but rather a landmark where they are welcomed and taken care of.

• Sick bay

A sick bay is a compartment in a ship used for medical purposes — the ship's hospital.

The sick bay will contain the ship's medicine chest which may be divided into separate cabinets such as a refrigerator for medicines which require cold storage and a locked cabinet for controlled substances such as morphine. The sick bay and the medicine chest should be kept locked, with the keys only being available to the medical officer and the ship's master.

Sick bays appear in popular science fiction franchises, such as Battlestar Galactica or the Star Trek series, as the medical facility on board a starship.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

• Surgicenters

Surgicenters or Ambulatory surgery centers (ASC) are also known as outpatient surgery centers or same day surgery centers. Medical facilities where surgical procedures not requiring an overnight hospital stay are performed are sometimes called surgicenters. Such surgery is commonly less complicated than that requiring hospitalization. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care.

An ASC is a health care facility that specializes in providing surgery, including certain pain management and diagnostic (e.g., colonoscopy) services in an outpatient setting. Overall, the services provided can be generally called procedures. In simple terms, ASC-qualified procedures can be considered procedures that are more intensive than those done in the average doctor's office but not so intensive as to require a hospital stay. An ambulatory surgery center and a specialty hospital often provide similar facilities and support similar types of procedures. The specialty hospital may provide the same procedures or slightly more complex ones and the specialty hospital will often allow an overnight stay. ASCs do not routinely provide emergency services to patients who have not been admitted to the ASC for another procedure.

• Urgent care

Urgent care is the delivery of ambulatory care in a facility dedicated to the delivery of medical care outside of a hospital emergency department, usually on an unscheduled, walk-in basis. Urgent care centers are primarily used to treat patients who have an injury or illness that requires immediate care but is not serious enough to warrant a visit to an emergency room. Often urgent care centers are not open on a continuous basis, unlike a hospital emergency room which would be open at all times.

The initial urgent care centers opened in the 1970s. Since then this sector of the health care industry has rapidly expanded to an approximately 10,000 centers. Many of these centers have been started by emergency room physicians who have responded to the public need for convenient access to unscheduled medical care. Much of the growth of these centers has been fueled by the significant savings that urgent care centers provide over the care in a hospital emergency department. Many managed care organizations (MCOs) now encourage their customers to utilize the urgent care option.

Other ambulatory healthcare facilities

Urgent care centers are distinguished from other similar types of ambulatory healthcare centers.

Emergency departments

Emergency departments are located within hospitals and are prepared to care for patients suffering true emergencies, such as myocardial infarctions ("heart attacks"), serious motor vehicle accidents, suicide attempts, and other such life-threatening conditions. Being located within a hospital, these centers are positioned to provide ready access to major surgeries and

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

critical care units. Emergency departments are usually staffed by physicians with specialized training or board certification in emergency medicine. Most states in the USA require all hospitals to house an emergency department within the hospital building. A few states in the USA allow freestanding emergency departments to be built outside of a hospital building. Many authorities would consider this type of facility to be a high-acuity urgent care center, rather than a true emergency department.

Primary care offices with extended hours

Many primary care offices are open for some hours in the evenings and weekends. However, unless these centers are open for walk-in patients at all times when open for patients, offer on-site x-ray facilities, and care for most simple fractures and lacerations—these primary care physician offices are not considered to be true urgent care centers.

Walk-in primary care offices

Allowing walk-in patients is not a sufficient criterion to define a physician office as an urgent care. If the office does not offer the expanded services and significant after-hours care, then the physician office would not fit the definition of an urgent care center.

Mid-level provider offices in retail stores

In 2000, medical treatment centers opened in retail stores with an on-site pharmacy. These centers are generally staffed with nurse practitioners or physician assistants. Prices are generally posted in public view and patients can shop while waiting. These retail clinics are not true urgent care centers because of the limited level of care that can be provided without a physician or proper equipment on site. Concerns about conflict of interest and incentives to over-prescribe medications in a facility rented from a pharmacy have yet to be fully addressed by organized medicine or governmental agencies, but the American Academy of Family Practice has issued Desired Attributes for Retail Clinics.

Criteria for Urgent Care Centers

The Urgent Care Association of America established criteria for urgent care centers in April 2009 - The Certified Urgent Care Center designation. These criteria define scope of service, hours of operation, and staffing requirements. Information and Certification criteria are available to the public on the UCAOA website.

Organized medicine and urgent care

The Urgent Care Association of America (UCAOA) holds an annual spring convention and, also, offers an annual fall conference. Many leaders in organized urgent care medicine anticipate the full establishment of urgent care as a fully-recognized specialty.

Urgent Care Outside of the USA

Although the urgent care movement began in the USA, urgent care centers have become an important component of healthcare delivery in several other countries, including Canada, England, Ireland, Australia, New Zealand and Israel. In March, 2008 the Accident and Medical Practitioners Association and the Australasian Society for Emergency Medicine

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

hosted the first international urgent care conference in Auckland, New Zealand. New Zealand is the first country to recognize urgent care as a distinct medical specialty.

Specialized services

One sign that the urgent care industry is truly emerging as an important sector of the healthcare industry has been the development of supporting industries with products and services directed at supporting patient care and business practices of urgent care centers.

Point-of-care medication dispensing

Point-of-Care dispensing enables healthcare practitioners in the urgent care setting to ensure that their patients receive their prescription prior to leaving the clinic. To offer this service to patients, urgent care centers generally contract with a point-of-care dispensing corporation. Point of Care dispensing enables physicians (and in some states, other licensed healthcare practitioners) to dispense at urgent care facilities. Unlike a pharmacy, practitioners may only dispense to their own patients. Regulations regarding state pharmacy law vary from state to state. Dispensing by a healthcare practitioner is not legal or quite limited in certain states, such as Texas and New York.

Practice management software

Electronic medical records (EMR) and practice management software solutions have been specifically developed for use in urgent care.

Group purchasing organization

Group purchasing organizations, focusing on the urgent care industry, have been formed. The concept of these GPOs is that they join hundreds of urgent care centers together to allow the type of price bargaining that previously was only available to hospitals.

Medical malpractice insurance

Malpractice insurance offerings unique to the urgent care industry have begun to be widely discussed in light of the fact that many insurers do not recognize the reduced malpractice risk of urgent care centers. Insurers that recognize this reduced risk do not group urgent care centers with hospital emergency physicians and other high-risk specialties. Features of this type of insurance may include no charge for tail coverage when providers leave ("tail coverage" is coverage for malpractice claims which may arise after termination of a policy), 3-5 day approval of new providers, no additional premium when providers are added to the policy, per visit FTE rating, and lower premiums.

2’. I also prepared another article about Afghanistan Hospitals for a seminar and presentation which is as below:

Hospital (”ﺷﻔﺎﺧﺎﻧﻪ Shifakhana “Dari)

Hospital literally "house of health" or "house of cure" is the term (”ﺷﻔﺎﺧﺎﻧﻪ Shifakhana “Dari) used in the historical context of Afghanistan architecture to designate a building constructed for medical purposes, equivalent of a hospital or a medical center of our day. Synonymous terms for this

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

type of building were the Persian words "Bimaristan", "Bimarkhana", or (for mental illnesses) "Timarkhana". This term is often used as a name for many hospitals in Afghanistan.

Hospitals have a long history in Afghanistan. Various types, from small and relatively simple medical clinics to large, complex, and costly, teaching and research hospitals are over there. Large hospitals include all the types of health care.

The most famous hospitals in Afghanistan are as below:

• Military 400 beds hospital:

this hospital is located in Kabul city capital of Afghanistan at a non crowded part of the city and is the largest, beautiful and standard hospital, it is built in a 100 hectares area, and has all care facilities, the main construction is 8 story building for hospital and 4 story building for the policlinic and other small and big subsidiary buildings. A big, beautiful and fresh green area is around and among of the buildings that all the patients and personnel can see it and enjoy of the beautiful flowers, trees, fountains and monuments. This hospital accept all kind of patients and has good experienced and high stage doctors nurses technicians, modern medical machines and instruments, it has also all medical departments, laboratories, x ray, blood bank, pharmacy and other necessary requirements. Besides of this it is a teaching and researching hospital too. All military doctors and medical students use this hospital. Sometimes it accepts non militaries patients too.

View of a small part of military 400 beds hospital

• Jamhoryat 400 beds Hospital:

this hospital is located at the center of Kabul city in a crowded part downtown, but the main building and all the subsidiary buildings are covered by a big, fresh and beautiful green area. This hospital is the largest and standard public hospital and like the military 400 beds hospital has all care facilities. The main construction 10 story building is newly build and renovated and subsidiary buildings are also renovated and added some new building to it. This hospital has 400 bed capacity and 1200 medical and non-medical staff are working to provide quality hospital services to the patients.

• Wazir Akbar Khan Hospital:

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

This hospital is located near the Military 400 beds Hospital, in a green and non crowded area in Kabul city and is the second level public hospital. It is just a hospital and doesn’t have a policlinic or clinic and also it has some special departments not all medical departments but it is also a teaching and researching hospital at its special fields. It has 100 beds facility and is, the main referral hospital for orthopaedic and emergency surgery in Afghanistan

• Alli Abaad Pulic Hospital:

this is a big public hospital for internal diseases, abnerval diseases. It is located near the Kabul Medical University, and of course it is a teaching hospital too. It has also a big beautiful and green campus and a patient feel friendly there.

• Ibn e Sina Sadri Hospital:

This hospital is a public hospital and located at amplitude of a hill and is specified just for pectoral diseases. It is an old hospital but now a days the Korean government added a new building to it and mobilized all the hospital with modern equipments and instruments. IbnSina Training Centre serves trainings workshops, seminars, meetings, events and celebrations as host for the personnel of the Ministry of Public Health, as well as for the doctors and staffs of the IbnSina Emergency Hospital for further improvement. IbnSina Emergency Hospital Training Centre is part of the extension building of the IbnSina hospital constructed with the financial support of Korean government in 2004. It is the first of its kind, not only in Kabul, but all over Afghanistan to be utilized as a centre for training workshop, and organization of events and celebrations. In addition to the main hall, this training centre includes four small rooms that could be used for group works and discussions for up to 48 people.

• Esteqlal Hospital:

this hospital is also a public hospital and located at one side of the city, this hospital is specialized for two important parts which are separated: 1st part is for burnt (combusted) patients and the 2nd part is for maternity of babies. this hospital called Red Crescent Hospital during last governments and donated by Afghan Sera Myasht “Afghn Red Crescent Organization” and International Comity of Red Crescent (ICRC), but now it calls Esteqlal Hospital and donates by the government.

• Malalai Zezhantoon Hospital:

This hospital is Specialized for the females and specialy for the mothers, this hospital present services for females and women, it is a maternity hospital, with more than 200 beds.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

View of a room in malalai Zezhantoon maternity hospital

It must be mentioned that there is a lot of Hospitals, poly Clinics, Clinics and Sanatoriums in Afghanistan and all of these donate by the government and patients do not have to pay for the services, they just have to buy the medicines that are not in the hospitals, but beside of these there are a lot of Government- Private and Private hospitals and Clinics. In these hospitals and clinics patients should pay for every services and medicines.

• Cure Hospital :

This Hospital is One sample of Government – private hospital which is located in Kabul city And is a portioned hospital, this hospital is Donated by the government and an American Private Company, patients should pay for all services done for them. This Hospital is specialized for internal diseases and surgical operations.

View of Entrance of the Cure hospital

• Kesha Health Care Center:

This is a Private health care center, and it is a big center but all services are for sale means for all services patient should pay even for staying there per night should pay.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

View of inside of the patient room in Cure Hospital

Map of Afghanistan

In Addition besides of these there are a lot of Doctor Offices all over the country and they are specialized due to the proficiency of the doctors, this kind offices have just two or three rooms, one for waiting, the other for doctor office and one for putting Instruments and equipments. In this kind offices patient just pay for the visiting the doctor and the doctor see the patient and give him or her a description due to his or her illness and the patient buy the medicines from Pharmacies which are near by the offices.

3. PRACTICAL ACTIVITIES:

During this period I had a look from two big Hospitals located in Bratislava and visited all departments and wards, one of these hospitals were depended to the church and the church funded it, but the other was medical faculty and hospital. At the first one which was funded by the church include all departments of a hospital, besides of them it had beds for the

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

patients, and was a good hospital. But if we compare it to our Hospitals in Afghanistan according to some points of view for example our society our traditions and other factors it isn’t comparable, for example it has some design problems and mistakes that they are not acceptable for us as Afghan Architectures according to the factors mentioned above, But of course they are not problems and mistakes here according to their society and traditions. But in my opinion there were some other design mistakes and problems which not depend to the society and traditions but depend to the Architects and designers and must be solved, for example the orientation of the building generally and the rooms especially was not acceptable, green area and natural environments which are very important and necessary points for a hospital were compressed at a 30 to 40 sqm. Two buildings which had three stories were located opposite of each other, distance between these two buildings was not as the standards, General site plan and locality of the hospital according to the Urban planning standards is a big mistake because it is located in a crowded and noisy street at the centre of the city, and some other design mistakes, these mistakes and problems were seen able to the other hospital too especially that it was a medical faculty. It had some educational and hospitality mistakes and problems too, of course in my point of view.

4. EXCURSE ACTIVITIES: -

During this time I had some excurses to the city, I visited some Historical places, buildings and Monuments, One of them was Palace of the Imperator of Austria which was a good historical palace, the other historical place was the old city of Bratislava, there were a lot of historical buildings and monuments, you can see the classic styles of Architecture over there, but if you have a look around the city there are a lot of modern style buildings and some where classic buildings that are mixed and made a good mixture of two deferent styles.

Historical Palace of the imperator of Austria

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Historical Palace of the imperator of Austria

Door of the Historical Palace of the imperator of Austria

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

I had another excurse to one project which was under work and saw the technology of their works, constructional materials and etc.

Anew building under work during pumping concrete

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Concrete mixer having ready mix concrete

Small mixers, handy trucks and other Construction instruments

Constructional Materials

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

Conclusions:

All activities done during this visiting are mentioned above and due to my visit and experiences during staying here I presumed conclusions as bellow:

• At first this visiting was very useful for me because I visit Slovak beautiful country, its Capital Bratislava City and its kind, good and high cultured people. • I visit the Faculty of Architecture, kind and knowledged professors, students and personals, lecture methods and studio works which were very interesting and useful. • I participate to the professors’ pedagogic activities, to the students’ activities, to the seminars and conferences that were very interesting knowledge and useful. • I researched about an important article (Health Care Facilities, Hospitals) using the books from library of the faculty, books

Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14

given to me of professors, and internet, and prepared printed file of this documents which is attached. • Prof. Mr. Staneslav and me prepared an article about Slovak and Afghanistan hospitals for the conference 13th of December and presented it for the participants that was very interesting for them. • I had some practical activities here, I visit two big hospitals of the Bratislava capital of Slovak, one new project on progress constructional technology and materials which all were very interesting and useful. • I had an excurse around the old city and historical places of Bratislava that was very interesting; there I visit classic and historical styles of architecture. • At the end of this conclusion I would like to say that this was very useful, interesting and good managed visiting that I enjoyed it very much. So at the end I would like to express my appreciation for this Scientific Training Program to the Faculty of Architecture of the Slovak University of Technology and Slovak Aid program for financial support of this project. I would like to say my hearth thanks to Professor Arch. Mrs. Veronika Katradyova PhD, and professor Arch. Mr. stanislav majcher for their guidance and assistance during the all time of my training visit. My thank belongs also to Ing. Juma Haydary, PhD. the coordinator of this project in the frame work of which my visit was realized.

Besides of this I would like to appreciate all professors and personnel of the faculty of Architecture for their good behaves and hospitality. cÜÉyA TÜv{A Wtâw f{t{ YtÜâÖA December, 14, 2010

SLOVAK UNIVERSITY OF TECHNOLOGY IN BRATISLAVA FACULTY OF ARCHITECTURE INSTITUTE OF HOUSING AND CIVIC STRUCTURES

HEALTH CARE FACILITIES HOSPITALS

RESEARCHES

In the frame work of the project

No. SAMRS 2010/10/1

“Development of human resource capacity of Kabul polytechnic university”

Funded by

UÜtà|áÄtät ECDC cÜÉA Wtâw f{t{ YtÜâÖ

November, 30, 2010 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

PREFACE:

This article is prepared after a long research from some books, lectures, seminars’ and sites of internet for using as a guidance in health care facilities and hospital designs.

In this article is tried to describe all kinds of health care facilities and hospitals with the classifications and specifications of each class and some samples and pictures are shown too.

This article may help our students during designing such buildings and facilities, for make a good design, students have to know and understand the specifications of all kinds of these facilities and buildings,

I hope that, this would be a useful guidance for those, that are interested for designing such buildings and facilities, of course it is just a small portion of knowledge depending to this very important and huge article, and I’m hopeful that the readers would excuse me if there is some shortages in the subject.

Besides of this I Daud Shah Faruq professor of Kabul Poly Technic University the author of this article would like to express my appreciation for the Scientific helps of those kind professors of the Faculty of Architecture, of the Slovak University of Technology and specially I would like to say my hearth thanks to Professor Arch. Mrs. Veronika Katradyova PhD, and professor Arch. Mr. stanislav majcher for their guidance and assistance for preparing this article.

Best regards cÜÉyA Wtâw ft{t{ YtÜâÖ

November, 30, 2010

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

HEALTH CARE FACILITIES Contentes:

1. Preface……………………………………..1 53. Inpatient care……………………….....…30 2. Contents……………………………….……2 54. History…………………………...……....30 3. Introductio……………………………….…3 55. Physician hospital care models………...... 30 4. Oveview………………………………...... 3 56. Isolation ward (medicine)……………...... 31 5. Emerging Issue………………………….….5 57. Design……………………………..….….31 6. Classification……………………....…...... 5 58. Use…………………………………..…...31 7. Subcategories………………………….....…5 59. Nurse-led clinic……………………..……32 8. Abortion clinic……………………………...6 60. Definition………………………..…….....32 9. Adult daycare center……………….……....6 61. Overview………………………...…….....32 10. Ambulatory surgery center………………...7 62. Review of Evidence………………..….....32 11. Clinics……………………………...….....…8 63. Nurse-managed health center……….…....33 12. Etymology…………………...………....…..9 64. Overview………………………………….33 13. Function……………………...……..……....9 65. Services Provided……………..……...…..33 14. Types……………………………...... ……...9 66. Polyclinics……………………...……....…34 15. Examples…………………………….....…10 67. Polyclinics in England………………....…34 16. Convenient care clinic………..……...... …10 68. Operational polyclinics………...……....…34 17. Overview………………………….……….10 69. Polyclinic services……………...……...…35 18. Services Provided…………………..…..…11 70. History………………………...……….....35 19. Nurse Practitioners and Physician 71. Rationale………………….…………...….36 Assistants in Convenient Care Clinics...... 11 72. Funding………………………………...…37 20. Doctor's office……………………….....…11 73. Implementation……………………………37 21. Facilities…………………..………..…..…11 74. Opinion……………………………………38 22. Free clinics……………………………...... 12 75. Sanatorium………………….……………..40 23. History………………………………...….12 76. History………………………….……....…40 24. Departure of community clinics…..…...... 13 77. As a resort……………………..…………..42 25. Hospitals…………………………...…...... 13 78. In popular culture………………..…..…....42 26. Etymology……………………...…..….…13 79. Sanyukai………………………….…….....43 27. Types………………………..………...….14 80. Goal…………………………….……....…43 28. General Hospitals……………….…….….14 81. Structure…………………………….….....43 29. Specialized Hospitals………………....…..15 82. Sanyu clinic……………………….…....…43 30. Teaching Hospitals……………….…..…..15 83. Outreach program…………………………43 31. Clinics……………………………….…....15 84. Legal advice…………………………….....44 32. Departments………………………..…….15 85. Social Center……………………...…….…44 33. History……………………………..…..…16 86. Sick bay………………………...……....…44 34. Roman Empire…………………….…..…18 87. Surgicenters…………………….……....…45 35. Medieval Islamic world………….….…...18 88. Urgent care…………………….……….....46 36. Main article: Bimaristan………….………18 89. Other ambulatory healthcare facilities….....47 37. Medieval Europe………………….……...19 90. Emergency departments…………….….....47 38. Colonial America………………………...20 91. Primary care offices with extended hours...47 39. Modern era………………………….....…20 92. Walk-in primary care offices…………...…47 40. Criticism…………………………….…....21 93. Mid-level provider offices in retail stores...47 41. Funding……………………………....…..21 94. Criteria for Urgent Care Centers…………..47 42. Buildings (Architecture)……………....…22 95. Organized medicine and urgent care..…....48 43. Hospital ship……………………….....….24 96. Codes for urgent care…………………...... 48 44. Hague Convention……………………….24 97. Postgraduate fellowship training…….....…48 45. History………………………………..…..26 98. Urgent Care Outside of the USA………....48 46. U.S. Navy Hospital Ships……………...... 26 99. Specialized services………………...…...... 49 47. Legal status…………………..……….…..27 100. Point-of-care medication dispensing……...49 48. Hospital train………………...………...…27 101. Practice management software……….…...49 49. Hospital trains in history………………....28 102. Group purchasing organization………...…49 50. The Sovereign Military Order of Malta….28 103. Medical malpractice insurance……………49 51. Lifeline Express……………………….…29 104. References………………………..…….....49 52. Chinese eye hospital trains……………....29 105. Conclusions…………………………….....51

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

HEALTH CARE FACILITIES

INTRODUCTION Health Care Facilities and services require a wide range of buildings of very different sizes and types. The basic components of the total health building estate and the means by which they are procured vary from country to country. Everywhere the balance is shifting away from inpatient care, with consequent changes in the location and content of new buildings, and increasing modification of existing buildings to serve new needs. In 1948, Britain’s new National Health Service (NHS) inherited two main kinds of ‘acute hospital’ -the local authority infirmaries that incorporated former workhouses and voluntary hospitals, some of which had a medical teaching role and associated medical schools. There were also fever hospitals, tuberculosis sanatoria and small local cottage hospitals, as well as clinics that were operated by local authorities. General medical practitioners (GPs) were mainly sole operators and owners of their own premises. A few major hospital developments were started in the 1950s, but it was the Bonham Carter Report which led to the 1962 Hospital Building Plan that consolidated the concept of the ‘district general hospital’ (DGH), typically serving a population of 200000 to 250000. Some of these were on new sites, and many of them amalgamated the functions of former infirmaries and voluntary hospitals. Cottage hospitals tended to disappear, but some re- emerged as community hospitals’ in the 1970s; some of these were associated with health centers combining general medical practice and health authorities’ preventive medicine services. Hospitals for a single specialty, such as maternity, ophthalmic and orthopedic, tended to be incorporated into DGHs. Some private hospitals exist outside the NHS, but most are quite small and provide mainly elective surgical services. In Britain, specialist physicians and surgeons are mostly salaried employees of the Hospital Trusts. In the USA they are mainly independent practitioners and their consulting facilities are usually in specialized office buildings where they have extensive diagnostic equipment. This means that American hospitals do not need the large out-patient departments that characterize British hospitals. Eastern European polyclinics have something in common with these American so-called ‘medical arts buildings’ traditionally, long-stay hospitals provided for the infirm elderly and those with mental illness or learning disabilities. The large remote asylums that housed the majority of these patients are being phased out in most developed countries. In Britain, from the 1950s, they began to be replaced by psychiatric departments of between 50 and 120 beds in DGHs. Smaller units, some free-standing, are becoming more common as part of a move towards providing ‘Care in the Community’ services, thus obviating the need for hospitalization. However, some special units for longer stay patients, or those with needs of greater security, are still required. Learning disability is seen as a social rather than a medical matter, and is provided for mainly by educational, social and housing services. Long-term care of frail elderly people requiring more than domiciliary nursing and support care, including those with problems of senility, is generally in nursing homes provided mainly in the private and voluntary sectors.

OVERVIEW Health care facilities encompass a wide range of types, from small and relatively simple medical clinics to large, complex, and costly, teaching and research hospitals. Large hospitals centers may include all the various subsidiary health care types that are often independent facilities. The entire health care system is under great pressure to reduce costs, and at the

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 same time, be more responsive to "customers". The aging are the heaviest users of health care services, and the percentage of the aging in our population is increasing significantly. At the same time, rapid technological advances, often involving very sophisticated techniques and equipment, make more diagnostic and treatment procedures available. The consequent increase in health care costs is not easily accommodated. Designers find increasing focus on limiting both construction costs and the costs of their design services, while compressing construction schedules and still meeting the highest quality standards. As cost pressures increase, health care facilities find themselves in increasing competition for both patients and staff. Architecture is often recognized as an important tool in attracting and retaining the best doctors and nurses, the most successful HMOs and insurance plans, and the most patients. Consumer decisions are based on cost, accessibility, quality of service, and quality of medical care. An aesthetically pleasing facility is a key aspect of the perceived quality of care. Health care is a labor-intensive industry, and much of that labor is highly skilled and highly paid. Since 60 to 75% of hospital expenses are labor costs, a design that increases operational productivity or efficiency and reduces staffing needs can have a major impact on the bottom line. (Don Blair, then at Perkins + Will, estimated that the cost of one full-time staff person is equivalent to the debt service on $1 million of borrowing per Architectural Record of May 1997.) Likewise, operations and maintenance costs over the typical 50-year life cycle of a hospital contribute up to 80% to the equation, so anything designers can do to facilitate maintenance and reduce total life-cycle cost will have tremendous returns on a relatively small up-front investment. Flexibility must be a basic feature of any new health care facility to keep it from rapid obsolescence in the face of changing needs and technologies. Health care facility needs are evolving rapidly, and the direction of that evolution is difficult to forecast with any certainty. New equipment technologies, new treatment methodologies, changes in diseases, and changes in the patient population base all impact the facilities that house them. Inpatient care is steadily being reduced while outpatient services are growing. There is increasing emphasis on special-care units and smaller satellite facilities rather than large, centralized facilities. In the past, communicable diseases were the major health problem, and sanitation or cleanliness was the main characteristic of a healing or therapeutic environment. Cleanliness remains extremely important, but there is increasing recognition of the value of a pleasant, easily-understood, and non-threatening environment for patient recovery. For example, the Plane tree Hospital philosophy of "demystifying medicine" emphasizes such a physical environment as part of its approach. Good design in the health care setting starts by recognizing the basic functional needs, but does not end there; it must also meet the emotional needs of those who use such facilities at times of uncertainty, dependency, and stress. The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of "protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy. While HIPAA does not regulate facilities design, its implications for healthcare facilities may affect location and layout of workstations that handle medical records and other patient information, paper and electronic, as well as patient accommodations. There is a noticeable movement from hospital-based acute care to outpatient care, and toward a more holistic, preventative, and continuous care of health and wellness. Sustainability must be a consideration for the design of all health care facilities. Many sustainable design features can be incorporated into health care facility design, including day lighting, energy and water conservation, nontoxic materials and finishes, and sustainable

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 operations and maintenance. Health care facility energy and water conservation standards must meet EP Act 2005, and Executive Order 13423 requirements. The Energy Independence and Security Act of 2007 (EISA), provides additional requirements for energy conservation.

EMERGING ISSUE There is an increasing emphasis on security, especially in large public facilities, and the need to balance this with the desired openness to patients and visitors. Evidence-based design; According to the Center for Health Design, "Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. Evidence-based health-care architecture creates safe and therapeutic environments for patient care and encourages family involvement. It promotes efficient staff performance and is restorative for workers under stress. These designs ultimately should improve the organization's clinical, economic, productivity, satisfaction, and cultural measures."

CLASSIFICATION A trend towards specialization has resulted in a growing number of health care types. Among them are hospitals, nursing homes, outpatient facilities, psychiatric facilities, rehabilitation facilities, hospices, assisted living facilities, congregate housing, adult day care facilities, and various specialized outpatient facilities. These facilities currently include sections on the following four specific building types:

Subcategories

These four above mentioned categories have the following subcategories:

5 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

• Abortion clinic

An abortion clinic is a medical facility that primarily performs or specializes in abortions. Such clinics may be public medical centers or private medical practices. As of 2010 there are 752 abortion clinics in America, at least one in every state (and the District of Columbia).

• Adult daycare center

Daycare centers may focus on providing care only for persons with Alzheimer's and related dementias or their services may be available for any disabled adult. Some daycare centers maintain a nurse on-site. Occasionally, there will be a small room devoted to clients to have vital signs checked, etc. by a medical assistant/nurse when needed. They may also provide transportation and personal care as well as counseling for caretakers.

Participation in adult day care often prevents re-hospitalizations and may delay admission to residential long term care. For participants who would otherwise stay at home alone, the social stimulation and recreational activities may improve or maintain physical and cognitive function. For caregivers, adult day care centers provide respite care, enabling caregivers to work or to have a break from their care giving responsibilities.

More than 4,600 adult day centers are operating in the United States providing care for 150,000 older Americans each day. Nearly 78 percent of adult day centers are operated on a nonprofit or public basis. Daily fees for services are almost always less than a home health

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 visit and about half the cost of a skilled nursing facility. Daily fees for adult day services vary depending upon the services provided. Average daily fees across the country are approximately $56.Funding for adult day services comes from participant fees, third party payers as well as public and philanthropic sources.

• Ambulatory surgery center

'Procedures' performed in ASCs are broad in scope. In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ambulatory surgery centers as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. In the United States today, more than 50% of Colonoscopy services are performed in ambulatory surgery centers.

The first ASC was established in Phoenix, Arizona in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals.

ASCs rarely have a single owner. Physicians’ partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. Occasionally, an ASC is entirely physician-owned. However, it is most common for development/management companies to own a percentage of the center.

Some large healthcare companies own many types of medical facilities, including ambulatory surgery centers. The largest operator by revenue is Surgical Care Affiliates, which is the former surgery division of HealthSouth Corporation, with 141 centers in 35 states. United Surgical Partners International (USPI) manages 138 centers in the US, Hospital Corporation of America manages 95. There are currently three publicly traded companies in the US who specialize in operating ASCs: Nova Med, AMSURG, and Symbion. There are also many privately held companies in the US who specialize in developing, managing and operating ASCs: Facility Development and Management.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

In the United States, more than 22 million surgeries a year are performed in more than 5,000 ASCs. ASCs are in all 50 states and can be found throughout the world. In the US, most ASCs are licensed, certified by Medicare and accredited by one of the major health care accrediting organizations.

Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises.

The national nonprofit organizations that represents the interests of ASCs and their patients is Ambulatory Surgery Center Association (ASC Association), which was formed in 2008 when the Federated Ambulatory Surgery Association (FASA) and the American Association of Ambulatory Surgery Centers (AAASC) merged.

Accreditation organizations are separate from the general trade organizations. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing for ASCs. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization where the public can get information on many aspects of ASCs. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards.

In 1996, California was the first state to require accreditation for all outpatient facilities that administer sedation or general anesthesia. Many other states have followed and require accreditation.

The three main accreditors of ASCs are American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and The Joint Commission.

• Clinics

General practice clinics are run by one or several general practitioners or practice managers. Physiotherapy clinics are usually operated by physiotherapists and psychology clinics by clinical psychologists, and so on for each health profession. Some clinics are operated in- house by employers, government organizations or hospitals and some clinical services are outsourced to private corporations, specializing in provision of health services. In China, for example, owners of those clinics do not have formal medical education. Health care in India, China, Russia and Africa is provided to vast rural areas by mobile health clinics or roadside dispensaries, some of which integrate traditional health practices. In India these traditional clinics provide ayurvedic medicine and unani herbal medical practice. In each of these countries traditional medicine tends to be a hereditary practice.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

Etymology

The word derives from the Greek klinein meaning to slope, lean or recline. Hence kline a couch or bed, klinikos sloping or reclining and to Latin clinicus. An early use of the word clinic was, 'one who receives baptism on a sick bed'.

A medpunkt (health care access point) delivers primary health care to the residents of the village of Veliki Vrag in Nizhny Novgorod Oblast, Russia

Function

The function of clinics will differ from country to country. For instance, a local general practice run by a single general practitioner will provide primary health care, and will usually be run as a for-profit business by the owner whereas a government specialist clinic may provide subsidized specialized health care.

Some clinics function as a place for people with injuries or illnesses to come and be seen by triage nurse or other health worker. In these clinics, the injury or illness may not be serious enough to warrant a visit to an emergency room, but the person can be moved to one if required. Treatment at these clinics is often less expensive than it would be at a casualty department. Also, They sometimes have access to diagnostic equipment such as X-ray machines, especially if the clinic is part of a larger facility. Doctors at such clinics can often refer patients to specialists if the need arises.

Types

• In the United States, a free clinic provides free or low cost health care for those without insurance. • A Retail Based Clinic is housed in supermarkets and similar retail outlets providing walk in health care, which may be staffed by nurse practitioners. • A general out-patient clinic is a clinic offering a community general diagnoses or treatments without an overnight stay. • A polyclinic is a place where a wide range of health care services (including diagnostics) can be obtained without need of an overnight stay • A specialist clinic is a clinic with in-depth diagnosis or treatment on diseases of specific parts of the body. This type of clinic contrasts with general out-patient clinics, which deal with general diseases. o A Sexual health clinic deals with sex-related problems, such as prevention and treatment of sexually transmitted infections. o A fertility clinic aims to help those couples and individuals to become pregnant.

9 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

o An abortion clinic is a medical facility providing certain kinds of outpatient medical care, including abortion to women. Such clinics may be public medical centers or private medical practices.

Examples

• Tavistock Clinic, part of the British NHS, was founded in 1920's. One of its most celebrated members was R D Laing. • San Francisco's Suitcase Clinic is a prime example of a free clinic. • Christian Medical College & Hospital in Vellore, India has extensive roadside dispensaries and began as a one bed clinic in 1900. • The Edmonton Clinic is a joint venture of the University of Alberta and a government health care body Capital health, expected to be completed in 2011. • The Shyness Clinic founded by Zimbardo to assist those disabled by public or private shyness. • La Borde clinic in the Loire valley France, is an innovative psychiatric clinic where patients are liberated to actively participate in the running the facility. • The Mayo Clinic and Cleveland Clinic are two comprehensive health care systems. Both began as much smaller group practices that have grown into large medical programs in the United States, whilst retaining their names. • The Gary Burnstein Community Health Clinic, a non profit, volunteer supported Free Clinic in Pontiac, Michigan.

• Convenient care clinic

Overview Currently, there are over 1,000 CCCs located throughout the United States. Most CCCs are open seven days a week – twelve hours a day during the workweek and eight hours a day on the weekend. Because CCCs are such a new development, only a small percentage of Americans have received health care in a CCC setting. It is estimated, however, that the number of CCCs will increase dramatically in the near future. The 2008 Survey of Health Care Consumers, from the Deloitte Center for Health Solutions, finds the appetite for retail medical clinics is real, and growing, and the potential for future success substantial. The following statistics demonstrate the increase in consumer interest in retail clinics.

• More than 1 in 3 consumers surveyed are receptive to the idea of using retail clinics • 1 in 6 already have • Interest in retail clinics is especially high among "baby boomers", with nearly 38 percent saying they would use a retail clinic • By generation, seniors are the least likely and "millennials" are the most likely to use a retail clinic The survey says that these clinics are particularly popular among those who are identified as:

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

• Being in better-than-average health • More distrustful of hospitals and doctors • More likely to be suspicious of the medications that hospitals and doctors prescribe. A major driver of the walk-in clinic growth trend is the focus on cost. As more patients with higher deductibles seek out care options, the reduced cost of retail settings is a viable option for routine care. For example, according to one analysis, the typical cost of diagnosing an earache was $59 at a retail or walk-in provider, $95 in doctor's office, $135 at urgent care, $184 in an emergency room.

Services Provided Most CCCs treat adults and children over the age of 18 months. CCCs treat common family illnesses, such as: CCCs also provide preventative care, including health screenings, vaccinations, and physical exams. They may serve as sample collection points for blood, urine and feces for laboratory tests, which are then sent to external labs. By definition, CCCs offer a more narrow range of services (usually limited to 25 - 30 of the most common diagnoses) than are offered in traditional primary care offices. This limited scope of services is seen in both nurse practitioner and physician-staffed CCCs, and is an integral part of the CCC model. Nurse Practitioners and Physician Assistants in Convenient Care Clinics CCCs are usually staffed by Nurse Practitioners (NPs) or other advanced practice nurses. Some CCCs are staffed by Physician Assistants (PAs). Nurse Practitioners are registered nurses with advanced education and training who provide a broad scope of health care services. NPs engage in health promotion, patient evaluation, treatment, diagnosis, education, counseling, case management and coordination of care. One study found that patients of advanced practice nurses had similar outcomes to patients of primary care physicians. Physician Assistants are health care professionals licensed to practice medicine under physician supervision. With appropriate training and supervision, PAs can provide health care that is similar in quality to that of a primary care physician.

• Doctor's office

Facilities Doctor's offices worldwide contain the following: o Blood pressure cuff o X-ray o Eye chart

o Stethoscope o Scale o Otoscope o Ophthalmoscope o Microscope o Tongue depressor

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

o Thermometer o Tuning fork o Reflex hammer o Gauze o Cotton pads o Cotton swabs o First aid kit o Adhesive bandages o Gloves o Antiseptics o Hygiene wipes o Tissues o Paper towels o Paper cups o Sink o Tweezers o Hypodermic needles o Waiting room o Magazines

• Free clinics

A free clinic is a medical facility offering community healthcare on a free or very low-cost basis in countries with marginal or no universal health care. Care is generally provided in these clinics to persons who have lower or limited income and no health insurance, including persons who are not eligible for Medicaid or Medicare programs. In the US, almost all free clinics provide care for acute, non-emergent conditions. Many also provide a full range of primary care (including preventive care) and care for chronic conditions. Some free clinics include licensed pharmacies and dental services.

History The modern notion of a free clinic began in the 1960’s in San Francisco when Dr. David Smith founded the Haight Ashbury Free Clinics in 1967 during the summer of love in the Haight Ashbury district. Free clinics quickly spread to other Californian cities and the rest of the United States. In 1972 a meeting was held at the Shoreham Hotel in Washington DC where clinic staff from around the country gathered and listened to speakers including Dr. Smith. At this meeting the slogan “Health Care is a Right Not a Privilege” emerged as a theme. During the 1970s and 80’s free clinics continued to evolve and change to meet the needs of their individual communities, however some were unable to survive. Each free clinic was unique in its development and services, based on the particular needs and resources of the local community. There is a saying among free clinic organizations that if you have been to one free clinic you have been to one free clinic. The common denominator is that care is made possible through the service of volunteers, the donation of goods and community support. Funding is generally donated on the local level and there is little —if any— government funding. Some free clinics were established to provide medical services in the inner cities while others opened in the suburbs and many student-run free clinics have emerged that serve the under-served as well as provide a medical training site for students in the health professions.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

While both free and community clinics provide many similar services, free clinics today are defined by the US National Association of Free Clinics as “private, non-profit, community based organizations that provide medical, dental, pharmaceutical and/or mental health services at little or no cost to low-income, uninsured and under insured people. They accomplish this through the use of volunteer health professionals and community volunteers, along with partnerships with other health providers.” Some free clinics rival local government health departments in size and scope of service with multi-million dollar budgets, specialized clinics and numerous locations.

Departure of community clinics Eventually a schism evolved among clinics where some held fast to the idea that services should be provided free of charge to the patient while others felt that the services should be paid at least in part by the patient. This second group of clinics became known as community clinics and would offer services on some sort of sliding fee schedule based on the patient's ability to pay. In the early 1970’s Ramparts Magazine said that in order to survive, free clinics would have to be equally active providing service as they were with the mimeograph machine. In other words, the service provided by the doctors was of equal importance to insuring that people have a right to health.

• Hospitals

A hospital, in the modern sense of the word, is an institution for health care providing patient treatment by specialized staff and equipment, and often, but not always providing for longer- term patient stays. Its historical meaning, until relatively recent times, was "a place of hospitality", for example the Chelsea Royal Hospital, established in 1681 to house veteran soldiers. Today, hospitals are usually funded by the public sector, by health organizations, (for profit or nonprofit), health insurance companies or charities, including by direct charitable donations. Historically, however, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Conversely, modern-day hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in history, this work was usually performed by the founding religious orders or by volunteers. Today, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters which still focus on hospital ministry.

Etymology

During the Middle Ages hospitals served different functions to modern institutions, being almshouses for the poor, hostels for pilgrims, or hospital schools. The word hospital comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality that is the relation between guest and shelterer, hospitality, friendliness, hospitable reception. By metonymy the Latin word then came to mean a guest-chamber, guest's lodging, and an inn. Hospes is thus the root for the English words host (where the p was dropped for convenience of pronunciation) hospitality, hospice, hostel and hotel. The latter modern word derives from Latin via the ancient French romance word hostel, which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word hôtel. The German word 'Spital' shares similar roots.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found.

Types

Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for several days or weeks or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others often are described as clinics.

Norfolk and Norwich University Hospital in the East of England

All India Institute of Medical Sciences in Delhi, India

General Hospitals

14 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals have their own ambulance service.

Specialized Hospitals

A teaching hospital in Canada

Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. Within the United States, most hospitals are nonprofit.

Teaching Hospitals

A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school, nursing school or university.

Clinics

Departments

Hospitals vary widely in the services they offer and therefore, in the departments they have. They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such

15 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 as cardiology or coronary care unit, intensive care unit, neurology, cancer center, and obstetrics and gynecology.

Resuscitation room bed after a trauma intervention, showing the highly technical equipment of modern hospitals

Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments and/or release of information department.

History

In ancient cultures, religion and medicine were linked. The earliest documented institutions aiming to provide cures were Egyptian temples. In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing. Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" (Greek: ενκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium. The worship of Asclepius was adopted by the Romans. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.

16 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

View of the Askleipion of Kos, the best preserved instance of an Asklepieion.

A physician visiting the sick in a hospital, German engraving from 1682

According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya of Sri Lanka (reigned 437 BC to 367 BC) had lying-in- homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world. Mihintale Hospital is the oldest in the world. Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, and Medirigiriya.

Institutions created specifically to care for the ill also appeared early in India. King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physicians and nursing staff, the expense being borne by the royal treasury. Stanley Finger (2001) in his book, Origins of Neuroscience: A History of Explorations into Brain Function, cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted." However Dominik Wujastyk of the University College London disputes this, arguing that the edict indicates that Ashoka built

17 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs.

The first teaching hospital where students were authorized to practice methodically on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".

Roman Empire

The Romans created valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.

The adoption of Christianity as the state religion of the Roman Empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the Church to provide for the poor, sick, widows, and strangers; it ordered the construction of a hospital in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.

Medieval Islamic world

Main article: Bimaristan

In the medieval Islamic world, the word "bimaristan" was used to indicate a hospital establishment where the ill were welcomed, cared for and treated by qualified staff. The public hospital in Baghdad was opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century. The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas (ijazah) to those who were considered qualified to practice, an early parallel to modern medical schools. The first psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health.

Between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Hospitals in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. The Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan, as well as female physicians. Hospitals in the Islamic world featured competency tests for doctors, drug purity regulations, nurses and interns, and advanced surgical procedures. Hospitals were also created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

Medieval Europe

Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.

Hospicio Cabañas was the largest hospital in colonial America, in Guadalajara, Mexico

The church at Les Invalides in France showing the often close connection between historical hospitals and churches

19 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

Cancer Hospital at the University of Florida

Colonial America

The first hospital founded in the Americas was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicolás de Ovando, Spanish governor and colonial administrator from 1502–1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[22] Abandoned in the mid- eighteenth century, the hospital now lies in ruins near the Cathedral in Santo Domingo.

Conquistador Hernán Cortés founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was the Immaculate Conception, now the Hospital de Jesús Nazareno in Mexico City, founded in 1524 to care for the poor.

The first hospital north of Mexico was the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project, begun by the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by a colonial physician, Robert Giffard de Moncel.

Modern era

In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.

Guy's Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.

When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important

20 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 research center. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.

By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principle provider of health care in the United Kingdom, was founded in 1948.

In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax- exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School. In the late twentieth century, chains of for-profit hospitals arose in the United States. In the 2000s, modern private hospitals began to appear in developing countries such as India.

Criticism

While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly provide important help to patients with serious or rare health problems, hospitals also are criticised for a number of faults, some of which are endemic to the system, others which develop from what some consider wrong approaches to health care.

One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff, which dehumanises the patient and prevents more effective care as doctors and nurses rarely are intimately familiar with the patient. The high working pressures often put on the staff exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals often is voiced as a contributing factor to the feelings of faceless treatment many people complain about.

Funding

In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals also are still supported by the historical type of charitable or religious associations).

In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

Clinical Hospital Dubrava Modern Medical Center in Zagreb, Croatia.

Hospital care is thus relatively easily available to all legal residents, although free emergency care is available to anyone, regardless of nationality or status. As hospitals prioritize their limited resources, there is a tendency for 'waiting lists' for non-crucial treatment in countries with such systems, and those who can afford it, often take out private health care to get treatment more quickly). On the other hand, many countries, including for example the USA, have in the twentieth century followed a largely private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity' hospitals remaining today. Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct financial losses, ensuring that there is a clear disincentive to admit such patients.

As the quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this matter. Independent external assessment of quality is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international healthcare accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.

Buildings (Architecture)

Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.

However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate.

22 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

The National Health Service Norfolk and Norwich University Hospital in the UK, showing the utilitarian architecture of many modern hospitals

Hospital chapel at Fawcett Memorial Hospital, a for-profit facility operated by HCA

The cafeteria at Charlotte Regional Medical Center in Punta Gorda, Florida

As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:

23 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."

Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas hearken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.

Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital; this causes some hospitals to charge for the privilege of private rooms.

Ninewells Hospital, Dundee, Scotland is one of the largest hospitals in the world and also one of the largest teaching hospitals. Ninewells contains the first building in Britain designed by architect Frank Gehry, in conjunction with James F Stephen. The design was commissioned by Maggie's centres, the cancer support organisation, for their third centre at the hospital and was officially opened on 25 September 2003 by Bob Geldof. Ten million pounds has been spent redesigning and overhauling the paediatric department and, in June 2006, it was opened officially under the name Tayside Children's Hospital.

• Hospital ship

Hague Convention

Hospital ships were covered under the Hague Convention X of 1907. Article four of the Hague Convention X outlined the restrictions for a hospital ship:

• Ship must be clearly marked and lighted as a hospital ship • The ship should give medical assistance to wounded personnel of all nationalities • The ship must not be used for any military purpose • Ships must not interfere or hamper enemy combatant vessels • Belligerents as designated by the Hague Convention can search any hospital ship to investigate violations of the above restrictions

If any of the above restrictions were violated the ship was determined to be an enemy combatant and could be lawfully attacked. However, to deliberately fire on or to sink a Hospital ship complying with regulations would be a war crime.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

The Esperanza Del Mar, operated by the Spanish Department of Labor.

HMHS Britannic repainted white with large red crosses and a horizontal green stripe

The USNS Mercy

25 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

History

On 8 December 1798, unfit for service as a warship, HMS Victory was ordered to be converted to a hospital ship to hold wounded French and Spanish prisoners of war. Another early example of a hospital ship was USS Red Rover in the 1860s, which aided the wounded soldiers of both sides during the American Civil War. It was the sighting by the Japanese of the Russian hospital ship Orel, correctly illuminated in accordance with regulations that led to the Battle of Tsushima during the Russo-Japanese War. Orel was retained as a prize of war by the Japanese after the battle. During World War I and World War II, some passenger liners were converted for use as hospital ships. RMS Aquitania and HMHS Britannic were two examples of ships serving in this capacity.

The last British Royal Yacht, the post World War II HMY Britannia, was ostensibly constructed in a way as to be easily convertible to a hospital ship, but this is now thought to be largely a ruse to ensure Parliamentary funding, and she never served in this role - reputedly her lifts were too small to take standard-sized stretchers.

The Brazilian Navy currently also operates several hospital ships on the Amazon and its tributaries. The Brazilians have an innovative and well-developed program of small, shallow- draft hospital ships that can provide medical care to the people in the interior of the vast Amazon region.

U.S. Navy Hospital Ships

The USNS Comfort

The Navy's two hospital ships, the USNS Mercy (T-AH-19) and USNS Comfort (T-AH-20) and are operated by Military Sealift Command. Their primary mission is provide emergency on-site care for U.S. combatant forces deployed in war or other operations. The ships' secondary mission is to provide full hospital services to support U.S. disaster relief and humanitarian operations worldwide.

Both ships contain 12 fully equipped operating rooms, a 1,000-bed hospital facility, digital radiological services, a medical laboratory, a pharmacy, an optometry lab, an intensive care ward, dental services, a CT scan, a morgue, and two oxygen-producing plants. Each ship is

26 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 equipped with a helicopter deck capable of landing large military helicopters. The ships also have side ports to take on patients at sea.

The ships are converted San Clemente-class supertankers. Mercy was delivered in 1986 and Comfort in 1987. Normally, the ships are kept in a reduced operating status in Baltimore, Maryland, and San Diego, California, by a small crew of civil service mariners and active- duty Navy medical and support personnel. Each ship can be fully activated and crewed within five days. The Comfort departed Baltimore for Haiti on January 16, 2010, to provide relief to victims of the country's massive earthquake.

Legal status

Modern hospital ships display large Red Crosses or Red Crescents to signify their Geneva Convention protection under the laws of war. However, a British air attack in 1945 sank the German hospital ship SS Deutschland with substantial loss of life; in the chaos of the war's closing days, she apparently had not been sufficiently marked as a hospital ship. Even marked vessels are not completely safe. Markings did not stop the sinking of the Australian Hospital Ship Centaur on 14 May 1943 off the coast of Queensland by a Japanese submarine, the German Hospital Ship Tübingen on 18 November 1944 at Pula by the Royal Air Force heavy fighters, or that of the Japanese Hospital Ship Buenosuairesu-maru on 26 November 1943 by an American B-24 bomber. In the last incident, the surviving crew members, still adrift and awaiting rescue five days later, were strafed by another B-24.

Some hospital ships, such as the SS Hope, belong to civilian agencies, and as such are not part of any navy.

The British Royal Fleet Auxiliary ship RFA Argus would be a hospital ship were it not for its armaments. When performing its medical role it is designated a 'primary casualty receiving ship'.

Armed vessels are disqualified from protection as a hospital ship under international law.

• Hospital train

A hospital train is a railway train with carriages equipped for the provision of healthcare. Historically this has ranged from trains equipped to transport wounded soldiers, with basic nursing and first aid facilities on board, to fully equip mobile medical centers, sometimes including operating theatres and nursing wards.

Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010

World War 1 hospital train.

A French Red Cross train bearing sick and wounded soldiers to Paris after passing through a field hospital in 1917

Hospital trains in history

Hospital trains began historically as troop trains, whose passengers were restricted to the wounded and dying. These trains had little or nothing in terms of medical facilities, but nurses travelled with the wounded, and the carriages of the trains were painted with red crosses, indicating their humanitarian role, to prevent enemy attack. Such trains were able to connect with hospital ships at French channel ports in order to repatriate wounded British soldiers during the First World War. There are numbers of extant journal entries from those who experienced the hospital trains of this era, many being referred to as "Great White Hospital Trains", as the carriages were often painted white or red and white.

The Sovereign Military Order of Malta

A hospital train car in Russia's National WWII Museum The Sovereign Military Order of Malta (SMOM), which is a sovereign entity (similar to an independent country, though with virtually no land), has a history of operating hospital trains

28 Prof. Daud Shah Faruq Health Care Facilities, Hospitals Nov, 30, 2010 through its military branch, known as the Military Corps of the Order. The operation of such trains reached its peak in the Second World War, but SMOM continues to operate such trains today. These include trains of carriages to provide shelter to refugees, with basic medical provision, and more technically-equipped trains, on which a wide range of medical services may be provided.

Lifeline Express

The Lifeline Express is an example of a modern hospital train of a highly technologically advanced type. Operated by the Impact India Foundation since 1991, these trains have had a profound impact on Indian rural healthcare provision. Operating in India, across the extensive network of the Indian Railways, the Lifeline trains (known colloquially as 'magic trains') move from town to town, remaining in a siding or platform at each town's railway station for perhaps a week or so, and providing advanced medical services (often beyond the capabilities of local medical centers) to those who apply for them, through a simple vetting or triage process, which ensures services are provided to those most likely to benefit. These trains include nursing wards, and full-scale operating theatres. They have resident medical and nursing staff, but for surgical procedures they rely upon the charitable provision of time and talents by Indian surgeons who spend some of their free time on board the trains for that purpose.

Terapevt Matvey Mudrov, a train-based mobile medical center of Russian Railways

Chinese eye hospital trains

The state-owned China Railways company currently operates four eye hospital trains, the fourth and latest being operated through the China South Locomotive and Rolling Stock Industry (Group) Corporation, and having entered service in early 2009 for the benefit of residents of the Sichuan Province. A range of ophthalmic surgeries, including the common cataract removal operation, can be provided free of charge on board the trains.

29 SLOVAK UNIVERSITY OF TECHNOLOGY IN BRATISLAVA FACULTY OF ARCHITECTURE INSTITUTE OF HOUSING AND CIVIC STRUCTURES

ﺷﻔﺎﺧﺎﻧﻪ ”SHAFAKHANA “DARI HOSPITALS OF AFGHANISTAN

PRESENTATION

In the frame work of the project

No. SAMRS 2010/10/1

“Development of human resource capacity of Kabul polytechnic university”

Funded by

UÜtà|áÄtät ECDC cÜÉA Wtâw f{t{ YtÜâÖ

December, 13, 2010 Hospitals of Afghanistan 13, Dec, 2010 (”ﺷﻔﺎﺧﺎﻧﻪ”Prof.Daud Shah Faru Shafakhana (dari

PREFACE:

This article is prepared just for the Conference presentation, planed by the Faculty of Architecture on Monday 13/12/2010.

definition, kinds and (”ﺷﻔﺎﺧﺎﻧﻪ This is a brief information about Hospitals (Shafa Khana “dari some famous and important Hospitals of Afghanistan.

This article is prepared here in Bratislava and has shortage of pictures and some more details, I searched in the internet to find some pictures and details but unfortunately I couldn’t, so I’m sorry for this, and I hope that the reader would excuse me.

In this article is tried to describe some kinds of health care facilities and hospitals of Afghanistan.

By the way I hope that it would be a little bit interesting for the readers and for the participants of the conference.

Best regards. cÜÉyA Wtâw ft{t{ YtÜâÖ

December, 13, 2010

Hospitals of Afghanistan 13, Dec, 2010 (”ﺷﻔﺎﺧﺎﻧﻪ”Prof.Daud Shah Faru Shafakhana (dari

Hospital (”ﺷﻔﺎﺧﺎﻧﻪ Shifakhana “Dari)

Hospital literally "house of health" or "house of cure" is (”ﺷﻔﺎﺧﺎﻧﻪ Shifakhana “Dari) the term used in the historical context of Afghanistan architecture to designate a building constructed for medical purposes, equivalent of a hospital or a medical center of our day. Synonymous terms for this type of building were the Persian words "Bimaristan", "Bimarkhana", or (for mental illnesses) "Timarkhana". This term is often used as a name for many hospitals in Afghanistan.

The most famous hospitals in Afghanistan are as below:

• Military 400 beds hospital this hospital is located in Kabul city capital of Afghanistan at a non crowded part of the city and is the largest, beautiful and standard hospital, it is built in a 100 hectares area, and has all care facilities, the main construction is 8 story building for hospital and 4 story building for the policlinic and other small and big subsidiary buildings. A big, beautiful and fresh green area is around and among of the buildings that all the patients and personnel can see it and enjoy of the beautiful flowers, trees, fountains and monuments. This hospital accept all kind of patients and has good experienced and high stage doctors nurses technicians, modern medical machines and instruments, it has also all medical departments, laboratories, x ray, blood bank, pharmacy and other necessary requirements. Besides of this it is a teaching and researching hospital too. All military doctors and medical students use this hospital. Sometimes it accepts non militaries patients too.

View of a small part of military 400 beds hospital

• Jamhoryat 400 beds Hospital this hospital is located at the center of Kabul city in a crowded part downtown, but the main building and all the subsidiary buildings are covered by a big, fresh and beautiful green area. This hospital is the largest and standard public hospital and like the military 400 beds hospital has all care facilities.

Hospitals of Afghanistan 13, Dec, 2010 (”ﺷﻔﺎﺧﺎﻧﻪ”Prof.Daud Shah Faru Shafakhana (dari

The main construction 10 story building is newly build and renovated and subsidiary buildings are also renovated and added some new building to it. This hospital has 400 bed capacity and 1200 medical and non-medical staff are working to provide quality hospital services to the patients.

• Wazir Akbar Khan Hospital

• Alli Abaad Pulic Hospital this is a big public hospital for internal diseases, abnerval diseases. It is located near the Kabul Medical University, and of course it is a teaching hospital too. It has also a big beautiful and green campus and a patient feel friendly there.

• Ibn e Sina Sadri Hospital

This hospital is a public hospital and located at amplitude of a hill and is specified just for pectoral diseases. It is an old hospital but now days the Korean government added a new building to it and mobilized all the hospital with modern equipments and instruments. IbnSina Training Centre serves trainings workshops, seminars, meetings, events and celebrations as host for the personnel of the Ministry of Public Health, as well as for the doctors and staffs of the IbnSina Emergency Hospital for further improvement. IbnSina Emergency Hospital Training Centre is part of the extension building of the IbnSina hospital constructed with the financial support of Korean government in 2004. It is the first of its kind, not only in Kabul, but all over Afghanistan to be utilized as a centre for training workshop, and organization of events and celebrations. In addition to the main hall, this training centre includes four small rooms that could be used for group works and discussions for up to 48 people.

• Esteqlal Hospital this hospital is also a public hospital and located at one side of the city, this hospital is specialized for two important parts which are separated: 1st part is for burnt (combusted) patients and the 2nd part is for maternity of babies. this hospital called Red Crescent Hospital during last governments and donated by Afghan Sera Myasht “Afghn Red Crescent Organization” and International Comity of Red Crescent (ICRC), but now it calls Esteqlal Hospital and donates by the government.

Hospitals of Afghanistan 13, Dec, 2010 (”ﺷﻔﺎﺧﺎﻧﻪ”Prof.Daud Shah Faru Shafakhana (dari

• Malalai Zezhantoon Hospital

This hospital is Specialized for the females and specialy for the mothers, this hospital present services for females and women, it is a maternity hospital, with more than 200 beds.

View of a small part of military 400 beds hospital

• Cure Hospital

View of Entrance of the Cure hospital

Hospitals of Afghanistan 13, Dec, 2010 (”ﺷﻔﺎﺧﺎﻧﻪ”Prof.Daud Shah Faru Shafakhana (dari

• Kesha Health Care Center

This is a Private health care center, and it is a big center but all services are for sale means for all services patient should pay even for staying there per night should pay.

View of inside of the patient room in Cure Hospital

Map of Afghanistan

cÜÉyA TÜv{A Wtâw f{á{ YtÜâÖ

December, 13, 2010