Why do a masterplan?

In the last blog post I wrote about only one part of what we be my master thesis - the design proposal of a new eye outpatient clinic. This time, I thought that I would write a bit about another part of my work here - making a master plan for the long-term development of Kolandoto Hospital. By masterplan, I mean a document that describes the development of the built environment at the hospital during the next 10 years. 

Background 1: The process of creating this masterplan started with mapping of the current site and site usage. Two aspects that have been important to know are the flows of people through the hospital site, and the medical zoning of the hospital. 

Six different medical zones have been categorized and identified. Those are: 

• Inpatient
• Outpatient
• Diagnostics and treatment
• Support, goods and materials
• Staff and administration
• Public and non-hospital functions

In the master plan layout, one should strive to differentiate between these zones. However, some support functions and some diagnostic functions will naturally be closely connected to functions belonging to other zones. The justification of not overlapping zones is to decrease the risk of transmission of communicable diseases and nosocomial infections, to safeguard the security and safety of patients, to differentiate between non-sterile spaces and sterile spaces, to ensure appropriate privacy to patients, to create an environment that minimizes room for errors, and to ensure a good working environment for the staff. 

Zoning illustration. 

Problems with the current zoning at the hospital include: 

• outpatient areas spread out over the whole hospital
• public access to the diagnostics and treatment functions (excluding lab)
• support, goods and materials spread out 
• unnecessary public functions inside the hospital
• inpatient and outpatient areas are overlapping

Site circulation and flows of patients, staff, materials and visitors across the hospital area plays an important part in making sure the hospital is an environment that does not cause illnesses or poor health. Just as with zoning, appropriately designed flows will decrease the risk of medical errors and nosocomial infections or diseases. Appropriate access and entrance points to the site for different types of flows need to be considered. 

The flows considered are: 

• emergency care
• inpatients
• outpatients
• delivery 
• visitors
• students
• staff
• goods and material 

Flows illustration. 

Current problems with the flows at the hospital include:

- 500 college students passing the site there times per day to get food in the kitchen and social hall

- the emergency flow of patients is too inefficient and delays the treatment of acute patients 

• the outpatient flow is too spread out and crossing inpatient flows
• the visitors flow is unnecessarily long and crossing other crucial flows

Reason 1: The two aspects of appropriate medical zoning and design of flows through a hospital is part of one reason as to why it is important to have a masterplan - to decrease the risk of mistakes and spread of infections. This has to do with the human right to health which includes patient safety and access to health care in an environment free from factors causing illness or poor health. 

Background 2: In the process of making a masterplan, we decided to identify what building/room/space needs there are at the hospital for the next 10 years. I organized a programming workshop attended by the heads of departments at the hospital in which we together created a list of construction needs for the the coming 10 years.

Reason 2: This relates to another reason for making a masterplan -  a reason that has more to do with the vision for the future than with the problems of today. The hospital is in the process of becoming a designated district hospital, but to fully become that some services and hence buildings need to be added. So, for the hospital to be able to lobby for full implementation of being a designated district hospital - a masterplan identifying the new constructions, renovations and extension needed can help smoothen and also speed up the process. Which then also helps the community around to get access to appropriate healthcare, and their human right to health to be fulfilled. 

Background 3: The hospital is set in a relatively resource scarce setting. And by resources I mean both money, materials and staff. When making plans for the future expansion of the hospital, it is important to consider this. To deal with the limited resources priorities need to be clarified. To do this, the hospital management and I had a meeting in which I facilitated a discussion regarding what out of all the different building needs they have during the next 10 years that should be prioritized. Decisions were made by the management team, and now they have a comprehensive list of priorities. 

I will use this list of priorities when I continue to develop the masterplan, and consider the order and timing of different constructions. The masterplan will also include a little bit more details about spatial needs, medical justifications and tentative budgets for around 8-10 of the first entities on the list. 

Reason 3: This relates to the third reason of creating a masterplan which has to do with funding of implementations and ownership of the development process. A proper masterplan in with agreed priorities, medical justifications constructions, and tentative construction budgets can be used as a base for resource prioritization within the hospital, and resource mobilization from possible donors for implementation of the identified building projects. It also provides better possibilities for the hospital management to really have ownership over the development process at the hospital, and especially in relation to the international development sector and possible donors.

MASS Design Group summarizes the need for a masterplan in a very good way: 

”A masterplan is necessary for buildings and services to operate as a unified system for efficient and effective healthcare delivery. Designing sites to accommodate programmatic, contextual, and climatic needs involves the strategic placement of spaces and services, well-designed site circulation, and provisions for future growth, while limiting risk factors that can confound infection control and service delivery.”

With greetings from a very warm Kolandoto in which we had 39 degrees C in the shade today,

/Annika