Building design for healthcare facilities
While the detail of architectural design of dialysis units is beyond the scope of this site, some design, layout and internal building concepts are useful to consider when plotting the fabric of a truly sustainable dialysis environment (1).
Intelligent design is now widely incorporated into northern European building design, reducing the energy requirements and improving occupant comfort by ~70% (2).
In Australian healthcare, cash-poor administrations have historically created dialysis infrastructure in any available space, whether for on-site in-centre facilities, or for suburban satellites. Vacant balconies, disused factories, re-cycled offices, derelict hotels, converted domestic houses – all have been used as ‘it will do’ dialysis sites.
Rarely – if ever – have dialysis buildings been purpose-planned for eco-sensitive design. Yet, of all patient-directed healthcare areas, dialysis units are sites where patients – and the same patients – spend prolonged, recurrent time, chair-tethered for 4 – 5 hours, 3 x weekly, for 156 individual episodes of care/year. And, many dialysis patients are in their 3rd or even 4th decade of maintenance therapy … same building, same cracks, same walls, same lack of design effort.
Most dialysis units are airless, lightless, depressing areas, often thrown together in unplanned haste as dialysis growth and demand dictates, and with little thought to optimisation of the environment – for either patients or staff.
We can – we should – do much better.
A recent blog at KidneyViews explores some internal design features that might offer a more pleasant milieu.
Eco-building design for business and commercial ventures is an advanced science and include the use of space, natural light, in-door vegetation, innovative decoration and, where appropriate, intimate privacy. But … not so for dialysis units, built as they are by budget-conscious hospital administrations. ‘Out-of-sight’ and ‘out-of-mind’ is a common thread.
External dialysis unit design also suffers badly. Building position and orientation, sun-strike and shade, natural lighting vs. artificial light, insulation against heat and cold, the avoidance of thermal bridging, the use of roof space… these and other features of passive eco-building design are not commonly considered part of the dialysis planning ‘landscape’.
A German study has shown that passive eco-buildings, while ~8% more expensive to build, so effectively reduce subsequent maintenance and operating costs that the greater expense of the initial construction is recouped within the first 1/3rd of the lifespan of the building (see graphs below).
Sensitive dialysis building design should include:
- Appropriately position and orientation to maximally access summer shade and winter sun.
- Natural light to minimize internal lighting.
- The replacement of fluorescent strip lighting by LED lighting systems.
- Internal plumbing that re-uses RO RW for toilets and cleaning.
- Internal plumbing that recycles RO RW for on-site waste of plastic wastes.
- Roof-top solar-array to solar-assist the power needs of the building, dialysis equipment and waste-processor.
- Roof top earth, both as insulation and to support vegetable planting – patient-tended and RO RW-watered … as both as a healthy food source for patients and staff, and as an enhancer of patient self-esteem and engagement.
- Partnership arrangements with adjacent buildings, businesses, parks, and gardens to share any unused RO RW.
A schematic to show eco-design
German data on building costs, energy demands, and return on investment
Passive buildings cost 8% more to build
But passive buildings cost less to power …
And passive buildings offer a better return on investment (RoI) over the lifetime of the building
- Fresenius Blue Paper: Reference = a commercial-in-confidence document: selectively available with permission Fresenius-AG.
- Thomsen KE, Witchen KB and the Euroace Committee. European national strategies to move towards very low energy buildings (1st Edition). Publisher: Statens Byggeforskningsinstitut, Aalborg University, DK-2970, Horsholm, Denmark. 2008: ISBN: 978-87-563-1329-2.