3°COHORTE MÓDULO 2 SEMANA 3: clase asincrónica Arq. Gustavo Di Salvo

Main ideas / lessons

• Course focus: View hospitals through architecture—not only as building design, but as a discipline involved in hospital infrastructure management and maintenance.
• Architect’s role in hospitals: The architect must translate medical care processes into spatial/physical design, bringing them into three-dimensionality (architecture as the physical realization of care).
• Core planning tool: the “Master Plan”:
  • The Master Plan is presented as the key management and planning instrument.
  • It combines two elements:
    • the medical program (care profile and processes defined with the medical team),
    • the architectural program (how those processes are spatially implemented).
  • It is used to anticipate what services will be like and to incorporate important quality and rights-related guidelines (e.g., patient rights) into the project—whether for new builds or remodeling.
• Methodology rooted in the scientific method: The architectural approach is described as a structured process that defines:
  • a frame of reference (asking all necessary questions),
  • followed by programming,
  • then a project/design phase,
  • then tender documentation,
  • then execution,
  • then maintenance/infrastructure management.

Methodology / step-by-step process (as described)

1. Establish a framework / frame of reference

   • Use a methodology aligned with the scientific method.
   • Define reference terms by asking all required questions.
   • Produce terms of reference that guide later work.

2. Programming phase (two stages)

   • 2a) Define the hospital’s role
     • Decide what role the hospital fulfills (based on medical needs and services).
   • 2b) Build the Master Program
     • Integrate:
       • functional aspects (care processes brought into architecture),
       • physical aspects (space/resource/architectural requirements),
       • financial aspects.
     • This step specifically requires synergy with the medical team.

3. Project / design phase

   • Primarily architect-led work that still requires input from specialists.
   • Includes participation not only from doctors, but also:
     • administrative staff,
     • teams related to teaching and research,
     • non-medical areas that support quality of health delivery.

4. Tender document preparation

   • Prepare a document with technical specifications for the full architectural project.
   • Use it to put the project out to bid and enable execution after awarding.

5. Execution phase

   • Architectural construction work is carried out.

6. Post-execution: maintenance and infrastructure management

   • Produce a maintenance manual for facilities.
   • Manage infrastructure and maintenance of the hospital.

How the architectural-medical program is developed (inputs and tools)

• Interview key stakeholders using forms/tools:

  • Heads of service
  • Administrative staff
  • Areas related to sterilization and pharmacy

• Use spreadsheets to build the program, illustrated with the Posadas Hospital example:

  • Observed model (current situation):

    • list functional units (e.g., consulting rooms),
    • list support premises needed to sustain those functional units,
    • document equipment and the current distribution of:
      • personnel,
      • physical resources,
      • equipment.
    • Include adjustments such as re-grading/reconfiguration of the observed model.

  • Proposed model (desired future state):

    • define scheduled care areas:
      • number and types of consulting rooms
      • example categorization: medical clinic, obstetrics, pediatrics, ophthalmology, etc.
    • define complementary support areas, such as:
      • infirmary,
      • offices,
      • waiting/living rooms,
      • bathrooms/restrooms,
      • hair salon (as applicable in the hospital program).
    • calculate total areas using:
      • sums of required spaces,
      • percentages for circulation,
      • design allowances (including space implications of wall dimensions and design elements).

• Remodeling assumption: The course emphasizes that hospitals are often not fully new; they are commonly remodeled, so the “observed vs. proposed” approach is used.

Example outcomes mentioned (Posadas Hospital)

• Posadas Hospital master plan (Ministry of Health involvement)

  • Hospital nationalized in 2007.
  • Master plan work took more than a year, surveying hospital services.
  • Project completed in 2012, reported as already in use with success.

• Facility/clinical upgrades referenced

  • Adult Intensive Care Unit:
    • prototype room reform based on current facility.
    • includes matching care processes (e.g., number of nurses and doctors per patient).
  • Outpatient clinics spatial organization
    • separation of technical vs. public circulation so they do not cross paths with medical activity.
    • clinics designed with components like:
      • interview area,
      • observation area,
      • access for specialists to see patients without mixing with public flows.
  • Equipment and infrastructure improvements
    • generators, new transformers,
    • updated imaging equipment (CT scanner, MRI machines, etc. as referenced),
    • hospitalization room redesign (example: from four beds to two beds with private bathrooms).

Closing message (key takeaway)

• Restructuring hospitals requires balancing:
  • historical and healthcare value,
  • current health reality,
  • and a future-oriented approach through state policy and committed management focused on people.
• Having a Master Plan is emphasized as crucial for future hospital management, especially during reforms.

Speakers / sources featured

• Speaker: Arq. Gustavo Marcelo Disalvo (architect; presented in the subtitles as “Gustavo Marcelo Disalvo” / “Arq. Gustavo Di Salvo”)
• Institution/source referenced: Ministry of Health (Argentina) — involved in the Posadas Hospital master plan
• Case study referenced: Posadas Hospital (nationalized in 2007)