illoo *1 D.6TLLOP@,.,IT TRE,,\If)S !iN jiOSP@@TAL -FACILITTES i@l TH.E UI\JITEI) STATlw6* John W. %lironi-n, M. j). C',iief, Divis-Lon of Hospital 7acilities Pub'Lic Health Serv.'Lce 7 d u. ca nd .eca.-,man,. of Washington, D. C. It is axiomatic in hospital design that "form follows function". This fact is the basis of the architect@-al desian of the modern hospital. It presents a challenge to the physician, the rurse, the pharmacist, the dietician, the admin- istr,-tor, the maintenance engineer, among a host of others who serve their fellowman through the hospital. The competencies of these health personnel must be *,ranslated in a word picture for the architect so that he can create a design which will be functional, realistic, economical and attractive, The role of the hospital has emerged as one which is recognized today as that of the health center for the community. it has become the mobilization depot of the manv essential and complex instruments of precision re(yaired by the medical and nursing staff for good patient care. in addition, it -must also contain the elements and facilities for comfortable housi-na and adeq-uate feeding of its patients and resident staff. To provide the proper blending of the facilities required for radioisotope therapy, surb-ical operations, oxygen tents, laboratory examinations out-patient clinies, pneumatic tubes, comptometers, vegetable prolAration, bake a7ens flower storage, chapels,, generators, boilers, elevators, storage,, d@ng rooms, staff lounaes, azioulances, perhaps even a helicopter and other essentials is not an easy task. 1"4or is it a one man job. A well des,-gned hospital represents the thinking and efforts of many people aver many years. The hospital of today, unlike one period in its evolution, is much more than the springboard to eternity. It is the starting.line of life; the place of -epair for the ill and impaired; the health university for all of us; and the place where man can serve @-mn to the fullest and in so doing serve his ,raker. Presented at U. S. lia,,ral radical School, -'iational Naval ,iedical @ienter, Bet'.-@,esa-al, ivhry@-nd, '@eptember 21, 'J.954. 2 There are approx-;.rately 7,000 hospitals in the United States exclusive of Federal hospitals. We '.-ave nearly 1,100,000 acceptable beds and about 154,000 nor,acceptable beds according to the respective State plans siYomitted under the 4 -Iospi+lal surrey and Construction F-rogram. Our national ?,osDital bed de J.--it as reflected in these State plans is in excess of 800,000 beds. The Federal agencies operating hospitals are the Army, Navy, Air Force, Public 'Health Service, Indian Service, and Veterans Administration. The latter three Federal-agencie8 serve the civilian-population and togeth6r have about 247,000 beds in operation today. The development of hospitals in this nation has a broad sociological and economic impact as well as a technical aspect. The passage of Public Law 725,, 79th Congress, in August 194(o. authorized the Hospital Survey and Construction Program. Under the provisions of this Act each of tke 46 States, Alaska, l@a,@i, Puerto Ricol the Vir@in Islands and the District of Columbia has developed an over-all plan relating to hospitals and related health facilities within its borders. These State plans are in reality a documentation of existing health resources, a description of the need A'o.- additional or expanded facilities., and a plan to acquire facilities to meet that need. Federal funds have been made available on a mt@ng basis of from one- third to two-thirds of the cost of the individual approved projects, The @te in its own discretion establishes the rate of Federal matching. The prog--am progress is as follows: 1. Number of.Proiects and ,'ost. As of June 30, 1954, 2,,263 projects have been approved,, which will add 109,207 beds. These projects also include 483 health centers. Total cost of these proj- ects represents one billion eight hundred fifty million dollars, of which the Federal Gover=ent is contributing nearly 618 million and the sponsors more than one billion two hundred mil@-on. 2, Cate-i Seventy-tizee (73) percent of all the projects (with b8,996 beds) are for -'Yeneral hospitals and ?eneral hospitals in combination with public health centers; 18 per- ?en,-, are oub@L4-z centers; '."@ie remaining 9 per-lent ('witl '40,Z,09 '4-eds,@ -ire mental, tuber---alos4-s., and chronic disease hospitals. 3. Construction Status. There are l,b73 of these projects (or 73 percent), adding 72,684 beds, which are open and in operation; 521 (23 percent), which will proiride 32,040 more beds, are under construction; t,.e rerainin., pro4ects with 4,4b3 beds are in preconstruction stages'. Of the projects which have been opened a.-id are in operation,, 1,225, or 73 percent, are general hospitals. These Drojects have added over 59,200 beds to our hospital resources. About 145 otier hospital projects are open for use.; these I-ave added over 13,400 beds in tuberculosis., mental, and chronic disease categor es. 4. New Facilities and Additions Fifty-nine percent, or 1,351 of the total number of pro-acts are completely new facilities; additions or alterations to existing facilities comprise-the remaining 41 percent. 5. Size of Communities. Of the new general hospitals approved, the majority (59 percent) are located l@n communities of less than 5,000. Only 8 percent are in cities of 50,000 or more people. Additions and alterations to existing -eneral hospitals tend to occur in the larger communities: 20 percent are in communities of less than 5,000 people; 31 percent are in communities of over 50.,ooo. 6. Prior Availa bilit.7 of ',facilities. Of the 891 completely new general hospital projects, 500 (56 percent) are located in areas which had no hospitals prior to the Hospital Survey and Construction Frogram; 186 (21 percent) are located in areas which had only nonacceptable facilities; the remining new facilities are being built in areas which were deficient in facilities prior to the program. 7. Reaional Distribution. tes. This The majority of approved projects are located in the Southern Sta census region has 1,181 projects, or 53 percent. The remainder are distributed 3 percent, 3.5 -- allows: "-L, @22 -ercent' -n -he -'\Iort.@, ,'antral -ta-,,es; -!Cb the North East States; and 2b3 (12 percent) in the Western States. 6. Bed Capac=. New hospitals are relatively small in bed capacity: 57 percent have fewer than 50 beds, 22 percent have from 50 to 99 beds, only 21 percent have 100 beds or more. Hospitals to which alterations or additions are being made are larger - b4 percent of these projects are hospitals with 100 or more beds. The lisdical Facilities Survey and Construction Act of 1954,, (@lic Law 482, 63rd Congress) amended the -Tospital Survey and Construction Act to provide a greater inducement to the States and local communities to plan for and construct Cil4 ties fa for the care of the chronically ill and impaired. This Act authorized 2 OOL) 000 and it das subsequently appropriated, to assist the States, on a dollar for dollar mat&ii@ basis to s-,xvey and plan four specific t-jpes of facilities. These types are (1) cnronic disease facilities; (2) diagnostic centers, or diagnostic and treatment centers; (3) nursing homes; and (4) rehabilitation facilities. These facilities, like those general, tuberculosis, chronic, mental hospitals, public health centers, authorized by the ori,,Yinal Act, must be non- profit in character render a community service and not discrimin ate against race, creed, or color. The 1954 amendments also authorized 60 million dollars for appropriation to assist in @ng part of the construction of the approved facilities. Amounts authorized gi=ually, through 1957 fiscal year are: (a) $20 1 3.lion for chronic disease facilities; (b) $20 million for diagnostic centers or diagnostic and treatment centers; (a) $10 million for nursing homes; (d) $10 million for rehabilitation facilities. 5 For fiscal year 1955 the Congress made available ';, 1 mill- on for the new ,:,2 amendments and ',.75 million for t'@ie older program. -,.-c-ect mist '-,e -'-n accordance with tae State plan, of hig'@i priority, and meet the minimum -equire- ments as provided by law and the Federal and State regulations. The Hospital Survey and Construction Program has provided a nation-wide program of-planning for and the construction of hospitals and related healt'.--i facilities through a cooperative relationship of local community, and State and Federal authorities to acquire better facilities and better patient care. In addition,, the program has helped rural communities to attract and retain physicians; emphasized coordination and integration of hospitals on a Sta;lle-wide basis; created an interest among the citizens of this and other countries in their health resources and facilities; stimulated construction of hospitals outside the program; stimulated a fusion between curative, preventive and restorative medicine to promote health ,ai-ntenance '.or our people and, established the 6tate agency as.the administrative aut'4-40r@Lty to which applicants must first go for approval in order to acquire subsequent Federal approval and financial assistance. The developmental trends in relationship to the technical details oL' the hospital in serving the public are also outstanding. These trends are the direct result of the chanes in medical care and the application of an ever growing body of knowledge concerning man and his relationship to his fellowman, to all other living and nonliving elements of our world and maybe of other world$ about which we my be in the process of learning. So at best the trends reflect our efforts to meet a state of flux which does not appear to show any inclination to stabilize. T' ie modern hospital is a better place in which to work and a better place ,n wh--ch to be treated +-'or an illness than those of the past. The physician !as more complete adjunct facilities to assist him in his ministering to the ill, the impaired and the injured. For example, (1) operating or @ac.,ii-g, and ?.-r ,-.cms Conrad..-, @@l ,i :,,-ray -@, ts, @e, evis4 on @az a ,;a- -,,us conditioning; (2) larger pharmacies with facilities for bulk compounding and storage; (3) more physical therapy and rehabilitation equipment; (/+) radioisotope laboratories; blood banks, encephalographic facilities; recovery rooms for post- operative patients; and, piped oxygen therapeutic facilities among other improvements. There is a very definite movement toward the provision of total re'-iab3'.1- itation facilities for all patients varying in degree with the indications and need. The character of medical practice today is requiring the development of out-patient departments. Psychiatric units for the early care of the mentally ill and for short term tl-.erapy are existent in the general hospitals of larger size. Even in some smaller ones psychiatric units are available pendina transfer of the mentally ill patient to a mental hospital. Nursing units have been reduced from the open ward of a large number of patients to smller numbers of patients in rooms. This aspect of the hospitals operation still needs considerable study. Toilets adjacent to bedrooms are a common finding as contrasted with a unit facility serving many. The use of color is being investigated as a therapeutic as well as decorative tool. Even in wnpationt areas the efficiency of staff and employees has been affected by the appropriate use of color. Fire safety planning and construction are present in all new hospitals. Fire and life safety programs for patients and staff exist in the well administered hospital. 7 On-site parking, =ift shops, fathers? rooms, snack bars and "baby sitter" 0 rooms serve the visitors to patients. @@orced d.-a-@'. vent'@:a@.-'-on @3,rd air zor.@-4.r.-4.oning are more @.-equen-tly -'our-d for the operating rooms and even total hospitals. This aspect of the ventilation of hospital buildings is receiving much study and great and new developments may be expected. Sound proofing, heat control and appropriate lighting are all under investigation in regard to human physiology and we may in time benefit from these studies. Inter-communication systems between patients and the nurses desks are effective features of the modern hospital. Radio and television are today quite common in patients' rooms. New methods of food preparation and disposal such as infra red ovens, garbage grinders and many other newer mechanical features are making personnel efficiency greater. The whole field of heat pumps, refrigeration, and lighting are the result of the application of the contributions of the physical scientist toward better patient care. The many operation and maintenance studies and methods such as central stores, central sterilizing, with use of distributing food carts and linen carts may serve well for certain types of hospital design. In time we may have moving corridor sections as well as our now utilized movable walls. In general a hospital must be custom built to properly ;rovide the demands milde'upon it. Too much standardization of room size, of design, of anything else will not be in the interest of the patient or the staff. The hospital of today is truly the health center'of the commun'6ty, As health maintenance programs develop the pabl,-c health center and the hospital come closer together. In times of national or local emergency of a catastrophic or -.ear n-mstr"nic nat,@e -',s @requentl-,- @v.,-ie iospita'L @nd its la'ooratory which is called upon for health protective services in addition to its routine contribution to the health of the community. T n conclusion,, the hospital is our health miversity and as such affects the lives of all of us in direct proportion to the way we use it.