Background: Healthcare structures are one of the most vital components of a society’s welfare infrastructure and the hospitals are the primary institutions that provide this service and medical care through diagnosis and treatment of people in need via equipped medical staff. Today, the governments are facing a variety of challenges and difficulties in the healthcare sector with the changing demographics, spread of chronic disease, rising healthcare costs and changing technologies. In the last couple of decades, with the development and the increase of private sector’s capabilities, both financially and technically, private sector companies have been involving more in the healthcare sector. One of the recent models adopted by many countries is the Public Private Partnership (PPP) model in healthcare. In order to accommodate all the services and functions required to fulfill the need of modern society, hospitals at a much larger scale are needed. Megastructure hospitals, also known as superhospitals, are the application of the “megastructure” concept to hospitals and healthcare structures that hold multiple purposes such as basic health services, commercial activities, administration, etc. Furthermore, site sustainability in healthcare is extremely important as the mentioned healthcare structures are a huge part of human life and have great impacts mostly on the environment, and also on the economics and society due to the size and operational complexity. Assessment of site sustainability of healthcare structures is an essential way to understand and develop the facilities and the projects, in order to be able to design and structure the new healthcare buildings in compliance with the sustainability criteria. Method: This study focuses on qualitative and quantitative comparison and assessment of site sustainability of 12 European and 9 Turkish PPP model megahospitals, that are shortlisted by checking against a set of criteria. The hospital assessment is based on 6 macro and 17 micro criteria of the ATHOSS tool. The findings of the assessment are verified with a series of interviews with both public and private sector employees. Furthermore, a set of guidelines are derived as a reference for future hospital designs to complement the ATHOSS approach. Results and Conclusion: The ATHOSS points of Turkish City Hospitals are relatively lower when compared to European Superhospitals. The overall rating of European ATHOSS average is 11.4 with hospitals scored between 9-17 points whereas the Turkish average is 7 with hospitals scored between 4-10 points out of 24. The European hospitals’ Macro Criteria averages are mostly higher than the Turkish ones despite the fact that the Turkish ones are relatively newer structures than the European ones. Turkish City Hospitals are significantly lacking on Macro Criteria 3 (Alternative Transportation) and Macro Criteria 5 (Connection to Natural World) compared to European Superhospitals. Furthermore, Turkish City Hospitals have significantly larger Gross Floor Area per bed than the European samples. This can be attributed to the large undefined voids inside the hospital buildings and the high number of covered or underground car park capacity. The Cost/Gross Floor Area and Cost/Bed of European hospitals are substantially larger than Turkish ones. Further Research: This research can be developed further by enlarging the sample group of megahospitals; analyzing more hospitals from other countries that were excluded in this research; using another tool to assess site sustainability and validate the findings of ATHOSS; analyzing other areas of sustainability in each sample hospital; doing more interviews to collect and validate more data and study more recently operational hospitals.
Contesto: Le strutture sanitarie sono una delle componenti più vitali dell'infrastruttura sociale di una società e gli ospedali sono le istituzioni primarie che forniscono questo servizio e assistenza medica attraverso la diagnosi e il trattamento delle persone bisognose tramite personale medico attrezzato. Oggi, i governi stanno affrontando una serie di sfide e difficoltà nel settore sanitario con i cambiamenti demografici, la diffusione di malattie croniche, l'aumento dei costi sanitari e il cambiamento delle tecnologie. Negli ultimi due decenni, con lo sviluppo e l'aumento delle capacità del settore privato, sia dal punto di vista finanziario che tecnico, le aziende del settore privato hanno coinvolto maggiormente il settore sanitario. Uno dei modelli recenti adottati da molti paesi è il modello di partenariato pubblico-privato (PPP) in ambito sanitario. Per soddisfare tutti i servizi e le funzioni richieste per soddisfare le esigenze della società moderna, sono necessari ospedali su scala molto più ampia. Le megastrutture ospedaliere, note anche come superospedali, sono l'applicazione del concetto di "megastruttura" agli ospedali e alle strutture sanitarie che hanno molteplici finalità come servizi sanitari di base, attività commerciali, amministrazione, ecc. Inoltre, la sostenibilità del sito in sanità è estremamente importante in quanto il Le strutture sanitarie citate sono una parte enorme della vita umana e hanno grandi impatti soprattutto sull'ambiente, nonché sull'economia e sulla società a causa delle dimensioni e della complessità operativa. La valutazione della sostenibilità del sito delle strutture sanitarie è un modo essenziale per comprendere e sviluppare le strutture ei progetti, al fine di poter progettare e strutturare i nuovi edifici sanitari nel rispetto dei criteri di sostenibilità. Metodo: Questa ricerca si concentra sul confronto qualitativo e quantitativo e sulla valutazione della sostenibilità del sito di 12 megaospedali modello PPP Europei e 9 Turchi, selezionati in base a una serie di criteri. La valutazione ospedaliera si basa su 6 macro e 17 micro criteri dello strumento ATHOSS. I risultati della valutazione sono verificati con una serie di interviste a dipendenti del settore pubblico e privato. Inoltre, viene derivata una serie di linee guida come riferimento per i futuri progetti ospedalieri per integrare l'approccio ATHOSS. Risultati e conclusioni: I punti ATHOSS degli ospedali Turchi sono relativamente inferiori rispetto ai superospedali Europei. La valutazione complessiva della media europea ATHOSS è 11,4 con gli ospedali segnati tra 9-17 punti mentre la media Turca è 7 con ospedali segnati tra 4-10 punti su 24. Le medie dei macro criteri degli ospedali Europei sono per lo più superiori a quelle Turche nonostante il fatto che quelle Turche siano strutture relativamente più recenti di quelle Europee. Gli ospedali Turchi mancano in modo significativo dei criteri macro 3 (trasporto alternativo) e dei criteri macro 5 (collegamento al mondo naturale) rispetto ai superospedali Europei. Inoltre, gli ospedali Turchi hanno una superficie lorda per letto significativamente maggiore rispetto ai campioni Europei. Ciò è da attribuire ai grandi vuoti indefiniti all'interno degli edifici ospedalieri e all'elevato numero di posti auto coperti o interrati. Il costo / superficie lorda e il costo / letto degli ospedali europei sono sostanzialmente maggiori di quelli Turchi. Ulteriori ricerche: Questa ricerca può essere ulteriormente sviluppata ampliando il gruppo campione di megaospedali; analizzare più ospedali di altri paesi che sono stati esclusi da questa ricerca; utilizzare un altro strumento per valutare la sostenibilità del sito e convalidare i risultati di ATHOSS; analizzare altre aree di sostenibilità in ogni ospedale campione; facendo più interviste per raccogliere e convalidare più dati e studiare più recentemente gli ospedali operativi.
Sustainable healthcare solutions. Site sustainability meta design strategies for public-private partnership model mega-healthcare structures
Ergur, Lara
2019/2020
Abstract
Background: Healthcare structures are one of the most vital components of a society’s welfare infrastructure and the hospitals are the primary institutions that provide this service and medical care through diagnosis and treatment of people in need via equipped medical staff. Today, the governments are facing a variety of challenges and difficulties in the healthcare sector with the changing demographics, spread of chronic disease, rising healthcare costs and changing technologies. In the last couple of decades, with the development and the increase of private sector’s capabilities, both financially and technically, private sector companies have been involving more in the healthcare sector. One of the recent models adopted by many countries is the Public Private Partnership (PPP) model in healthcare. In order to accommodate all the services and functions required to fulfill the need of modern society, hospitals at a much larger scale are needed. Megastructure hospitals, also known as superhospitals, are the application of the “megastructure” concept to hospitals and healthcare structures that hold multiple purposes such as basic health services, commercial activities, administration, etc. Furthermore, site sustainability in healthcare is extremely important as the mentioned healthcare structures are a huge part of human life and have great impacts mostly on the environment, and also on the economics and society due to the size and operational complexity. Assessment of site sustainability of healthcare structures is an essential way to understand and develop the facilities and the projects, in order to be able to design and structure the new healthcare buildings in compliance with the sustainability criteria. Method: This study focuses on qualitative and quantitative comparison and assessment of site sustainability of 12 European and 9 Turkish PPP model megahospitals, that are shortlisted by checking against a set of criteria. The hospital assessment is based on 6 macro and 17 micro criteria of the ATHOSS tool. The findings of the assessment are verified with a series of interviews with both public and private sector employees. Furthermore, a set of guidelines are derived as a reference for future hospital designs to complement the ATHOSS approach. Results and Conclusion: The ATHOSS points of Turkish City Hospitals are relatively lower when compared to European Superhospitals. The overall rating of European ATHOSS average is 11.4 with hospitals scored between 9-17 points whereas the Turkish average is 7 with hospitals scored between 4-10 points out of 24. The European hospitals’ Macro Criteria averages are mostly higher than the Turkish ones despite the fact that the Turkish ones are relatively newer structures than the European ones. Turkish City Hospitals are significantly lacking on Macro Criteria 3 (Alternative Transportation) and Macro Criteria 5 (Connection to Natural World) compared to European Superhospitals. Furthermore, Turkish City Hospitals have significantly larger Gross Floor Area per bed than the European samples. This can be attributed to the large undefined voids inside the hospital buildings and the high number of covered or underground car park capacity. The Cost/Gross Floor Area and Cost/Bed of European hospitals are substantially larger than Turkish ones. Further Research: This research can be developed further by enlarging the sample group of megahospitals; analyzing more hospitals from other countries that were excluded in this research; using another tool to assess site sustainability and validate the findings of ATHOSS; analyzing other areas of sustainability in each sample hospital; doing more interviews to collect and validate more data and study more recently operational hospitals.| File | Dimensione | Formato | |
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Thesis Lara Ergur.pdf
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220.28 MB
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220.28 MB | Adobe PDF | Visualizza/Apri |
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Thesis Lara Ergur.pdf
non accessibile
Dimensione
220.28 MB
Formato
Adobe PDF
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220.28 MB | Adobe PDF | Visualizza/Apri |
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https://hdl.handle.net/10589/174155