Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Problem Statement: From a sustainability point of view, hospitals offer their services without taking into consideration their impact on the environment, the interplay between various sectors, key elements of sustainable development and interconnectedness. This study represents an attempt to design a “virtual” green hospital facility that does more with fewer resources. Aims and Objectives: Contribute towards achieving sustainable and better quality healthcare services. To generate evidence and increase our understanding of the sustainability of hospital resource flows. Design a “virtual” green hospital. Research Method: The research approach consists of a comprehensive literature review, mixed with substantiated field research and interviews. The literature review provided an understanding, recommendations and interventions for the virtual project. These can be used to promote greater sustainability through WCRC’s healthcare system, energy efficiency and green hospital buildings. Interviews and questionnaires were used to collect the qualitative data. The interpretive technique was used to analyse the collected data. Consumption statistics of electricity, water and waste were used to collect the quantitative data. It was analysed using the green building rating tool. The rating tool awards points according to incorporated measures, and arrives at a total score after appropriate weighting. The green building rating tool was used to establish the rating of WCRC as it stands and what it could ideally be as a retrofit? The data was presented as demographic information in tables, charts and graphs, drawn from the collected data. Findings: The findings that emerged suggest that: a) green hospital buildings promote greater sustainability than the current modern healthcare hospital buildings at WCRC and retrofitting would promote greater sustainability; b) the majority of WCRC’s current healthcare provision is done in the conventional ‘business as usual approach’; c) the greatest weaknesses of the hospital is its heavy dependence (95% average) on nonrenewable energy sources of fuel, electricity and water; d) procurement isn’t focused in the bio-region; e) sustainability isn’t viewed as the cornerstone to influence policy; and f) the flow of resources gets conducted through socio-economic systems. Conclusion: The current design of the hospital needs to be retrofitted into a green building, which will promote greater sustainability. A higher rated green star building for WCRC would promote greater sustainability. Healthcare provision is done in the conventional ‘business as usual approach’. Therefore the healthcare system faces threats in the immediate future, which include the impact of climate change, over dependency on fossil fuels and increasing urban sprawl. A virtual green hospital is designed to reduce the overall impact of its built environment on human health and the natural environment by: • Efficiently using energy, water, and other resources; • Protecting occupant health and improving employee productivity; • Reducing waste, pollution and environmental degradation. Recommendations: In this sustainability criterion, a paradigm shift is required for WCRC hospital to go green and become sustainable. At a local scale WCRC needs to green the current hospital building by retrofitting. WCRC needs to energy switch from nonrenewables to sustainable renewable resources. Bioregional consumption and procurement needs to be practiced whilst establishing a local health movement to engage suppliers and focus on sustainability. / AFRIKAANSE OPSOMMING: Probleem stelling: Gesien van volhoubaarheids oogpunt, bied hospitale dienste aan sonder om te besin oor die impak op die omgeweing, die tussenspel tussen verskeie sektore, sleautel elemente van volhoubare ontwikkeling en die onderlinge aanknopings. Hierdie studie verteenwoordig ‘n poging om ‘n skyn groen hospitaal te ontwerp wat meer kan doen met minder hulpbronne. Oogmerk en Doelstellings: Om ‘n bydrae te lewer om ‘n volhoubare en beter kwaliteit gesondheidsdiens te bereik. Om bewyse te genereer en begrip aangaande die volhoubaarheid van hospitaal bronne vloei to verhoog/ Ontwerp van ‘n “skyn” groen hospitaal. Ondersoek Metode: Die benadering in die ondersoek bestaan uit ‘n omvattende literatuurstudie met ondersteunbare veld ondersoeke en onderhoude. Die literatuurstudie voorsien in die begrip, aanbevelings en tussentredes vir die skyn projek. Dit kan gebruik word om groter volhoubaarheid van die WKRS se gesondheidsisteem, energie effektiwiteit en groen hospitale te bevorder. Kwalitatiewe data was ingewin met behulp van onderhoude en vraelyste. Interpretasie was die tegniek wat gebruik was om data te analiseer. Verbruikstatistiek van elektrisiteit, water en afval was gebruik on kwantitatiewe data te kollekteer. Die analise daarvan was gedoen deur die gebruik van die groen gebou graderingsinstrument. Die graderingsinstrument ken punte toe volgens opgeneemde maatreëls en bepaal die finale gradering na gepaste afwegings. Die instrument was gebruik om die gradering van WKRS te bepaal soos dit is en wat die ideale terugbou sou wees. Die data word in tabelle en grafieke voorgelê soos wat dit verkry was van die gekollekteerde data. Bevindinge: Die bevindinge wat na vore gekom het dui aan dat: Groen hospitaal geboue bevorder groter volhoubaarheid dan die huidige moderne hospitaal geboue van WKRS en terugbouing sal groter volhoubaarheid bevorder. Die meerderheid van gesondheidsdiensvoorsiening deur WKRS geskied volgense die konvensionele benadering van “besigheid soos normal” Die grootste swakheid van die hospitaal is die swaar afhanklikheid van die hospitaal op nie-hernubare energie (95%) soos brandstof, elektrisiteit en water, Verkryging is nie gefokus op die bio-streek nie, Volhoubaarheid word nie beskou as die hoeksteen om belied te beinvloed nie en Die vloei van hulpbronne word herlei deur sosio-ekonomies sisteme. Sluiting: Die huidige ontwerp van die hospitaal moet terugverbou word na ‘n groen gebou wat groter volhoubaarheid sal bevorder. ‘n Hoër groenster bougradering vir WKRS sal groter volhoubaarheid bevorder. Voorsiening van gesondheidsdienste volgens die “besigheid soos normaal” benadering veroorsaak dat die gesondheids-sisteem bedreigiongs in die gesig staar soos die impak van klimaatsverandering, oorafhanklikheid van fosiel energie en verhoodge stadspreiding. Aanbevelings: Volgens die kriteria is ‘n paradigma verskuiwing nodig by WKRS om groen en volhoubaar te raak. Op ‘n plaaslike skaal is dit nodig vir WKRS om die huidige hospitaal terug te bou om groen te raak. Dit is nodig om energie veranderings te ondergaan van nie hernubare tot volhoubare, hernubare energie bronne. Die Biostreek verbruiking en verkryging moet gepraktiseer word terwyl plaaslike gesondheidsbewegings gevestig word om te onderhandel met verskaffers en te fokus op volhoubaarheid.

Thesis. 1977. M.Arch.--Massachusetts Institute of Technology. Dept. of Architecture. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / Bibliography : p. 127-128. / M.Arch.

Thesis. 1977. M.Arch.--Massachusetts Institute of Technology. Dept. of Architecture. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / Bibliography : leaves 67-68. / by William Henderson Sloan Jr. / M.Arch.

Healing and clinical work requires a complex choreography of architectural acoustic design in healthcare settings. In most healthcare settings, medical staff members conduct vital tasks that may have life-and-death implications. Patients visit the hospitals to heal. Their expectations include fast recovery, restful sleep, and privacy (i.e., speech privacy). However, sound environment qualities of the care settings often fall far from supporting the mission of hospitals. There is strong and growing evidence showing that effective soundscapes in healthcare settings potentially impact errors, healing and stress for patients, families and staff but it is still not clear what measures of the sound environment best predict key healthcare outcomes and what design strategies best impact those measures. By using a multi-method approach (i.e., objective and subjective noise level measurements, in-situ impulse response measurements, heuristic design analysis, theoretical studies, acoustic simulations and statistical analysis), this study aims to develop evidence based design strategies by statistically defining the relationships between three types of variables: (1) architectural floor-plate design metrics, (2) acoustic metrics, and (3) occupant response. The research is conducted in three phases. The first phase of the study compared the objective and subjective qualities of the hospital sound environments with different architectural designs, assessed the effectiveness of a newer acoustic metrics in capturing caregiver perceptions, and evaluated the impact of particular noise sources on caregiver outcomes. The second phase of the study tested the validity of an acoustic simulation tool in estimating the acoustic qualities of the healthcare soundscapes. The third phase of the study systematically explored the relationship between floor-plate design and acoustics of complex inter-connected nursing unit corridors. Even though the relationship between design and acoustics of proportional spaces (a.k.a. rooms with more traditional dimensions) has been well documented, the number of studies linking design and acoustics of complex non-proportional spaces such as inter-connected corridors still remains limited. The findings of the first phase show that critical care sound environments with different designs can vary drastically and impact caregivers` perceived wellbeing and task performance (e.g., patient auditory monitoring). Despite their extensive use, traditional noise metrics sometimes may not be effective in capturing unique characteristics of healthcare sound environments. This study validated the effectiveness of a new more detailed noise metric, "occurrence rate", in capturing the differences between acoustic characteristics of healthcare sound environments. Moreover, particular noise sources such as impulsive noises are likely to dominate the ICU sound environments and interfere with perceived caregiver health and performance. The findings of the second phase suggest the potential effectiveness of acoustic simulation tools (with hybrid prediction programs) in estimating the acoustic qualities of complex inter-connected hospital corridors. The findings of the third phase suggest the potential significant impact of design features of particular hallways (e.g., number of turns, corridor length, and number of branches) and overall floor-shape characteristics of inter-connected corridors (i.e., relative grid distance, and visual fragmentation) on reverberation time. Overall, in the units with shorter, more compact, fragmented corridors with multiple number of branching hallways, reverberation times are likely to be less. Moreover receivers located at the corridors with less number of turns from the sound source also potentially experience lower reverberation times. According to previous research, the human auditory system`s ability to monitor auditory cues is likely to be higher in the less reverberant sound environments.

China is engaged in the largest healthcare construction program in history, expecting to build more than 2,000 hospitals and a large number of healthcare facilities at all scale over the next few years. This once-in-a-lifetime construction boom provides a valuable opportunity to rethink Chinese hospital design, and especially to consider how to design modern hospitals that are effective and efficient in delivering care, and are responsive to the cultural needs of the Chinese people as well. This dissertation seeks to rigorously define these issues and develop metrics that link design to key healthcare processes. This study uses a range of concepts and analysis tools drawn from cross-culture organizational communications, evidence-based design, space syntax and other research traditions. This thesis develops and refines metrics for four main drivers of nursing unit design: space economy, staff efficiency, natural light and cultural preferences for communication. Communication among Chinese healthcare workers is strongly influenced by cultural preferences for patterns of authority and decision-making reflected in organizational culture and rooted in Confucian principles of hierarchical social structure (Dengji), social network (Guanxi) and face (Mianzi). While the dissertation builds on a longstanding tradition of research focusing on healthcare space economy and staff efficiency, new measures for cultural preferences are proposed and tested. Based on emerging theories of cross-cultural organizational communication by Hofstede and other scholars, and space syntax, this study particularly explores how cultural preferences for face-to-face communication are reflected in the design of Chinese nursing units. Based on the proposed metrics, the dissertation analyzes six pairs of Chinese and US nursing units, matched on layout type. While the Chinese nursing units appear Western, deeper quantitative analysis of their layouts reveals significant national differences in the application of unit typologies in China when compared to those in the U.S. It shows that Chinese hospital design is rooted in cultural preferences such as for positive energy (qi) based on Fengshui theory, and in Confucian principles of hierarchy, social networking and face.