Health Care Architecture in São Paulo, Brazil

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Health Care Architecture in Sao Paulo, Brazil: Evaluating Accessibility and Fire
Safety in Large Hospitals
Article in International Journal of Architectural Research · March 2007

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HEALTH CARE ARCHITECTURE IN SÃO PAULO, BRAZIL:

EVALUATING ACCESSIBILITY AND FIRE SAFETY IN LARGE
HOSPITALS
Sheila Walbe Ornstein, Rosaria Ono, Maria Elisabete Lopes,

Monteiro, R.Z., Gill, A.A., and Machry, H.S.
Abstract Keywords
This article describes and discusses procedures of Post-occupancy evaluation; large hospital
scientific and technical interest for applying the Post facilities; Brazilian health care architecture;
Occupancy Evaluation (POE), especially certain accessibility; fire safety.
questions related to accessibility and fire safety in
specialized and complex hospital buildings. For this
purpose, the building occupied by the Orthopedics Introduction
and Traumatology Institute (IOT) of the General
Hospital (Hospital das Clínicas) of the University of São
Post Occupancy Evaluation of
Paulo(USP), Brazil was chosen, as this institute is one of Hospitals in Brazil
the most important health centers in Latin America in Although the POE has been used in academic
its specialty. With approximately 25,000m2 distributed circles in Brazil since 1984 (Roméro; Ornstein,
throughout nine floors, the IOT offers services of a 2003), only in the 1990s did research in the field of
public nature to about 1,000,000 patients each year. performance evaluation begin, more specifically
Approximately 200 physicians and 890 nurses work in in relation to POEs focused on hospital buildings.
this building. The research described here was carried
Especially important in this process were studies
out in 2005 and involved teachers and graduate
students of the Faculty of Architecture and Urbanism published by Preiser (1998) on hospital systems in
of the same University of São Paulo. The work consisted the USA, Europe and Israel. Preiser, an architect
of the application of various methods for evaluating (Preiser; Vischer, 2005), and Bechtel (1997),
performance in use and the final results were organized an environmental psychologist, introduced
in a concise, user-friendly way in discovery maps. These the concept of inter-disciplinarity between
maps, which bring together synthesis of the different architecture and urbanism and other subjects,
evaluation standards regarding the building (opinions
and the need to include users’ perceptions
of users and appraisal specialists, the pertinent
legislation, and recommendations for each critical in research on built environments. Architects
point by floor and by sector), are a valuable tool for should be concerned not only with the health
decision-making by the building’s managers in terms of of buildings, but also, and especially, with the
interventions, remodeling projects, expansion and the physical and mental health of the people who
implementation of improvements. occupy them. The difficulties in applying the
Copyright © 2007 Archnet-IJAR, Volume 1 - Issue 1 - March 2007 - (13-25)
Archnet-IJAR, International Journal of Architectural Research

Health Care Architecture In São Paulo, Brazil:
14
Evaluating Accessibility And Fire Safety In Large Hospitals
POE to highly complex buildings in Brazil, such as With the experiences of ProArq-FAU-UFRJ, Fiocruz
SHEILA WALBE ORNSTEIN, ROSARIA ONO, MARIA ELISABETE LOPES, MONTEIRO, R.Z., GILL, A.A., & MACHRY, H.S.
hospitals, resulted in the delay of research in this became the first large institution in the field of
field. In addition, difficulties arose in accessing research, education and treatment in public
institutions of this type, especially in the case of health to bring together an in-house technical
private hospitals. One reason for this obstacle team in POE to provide information regarding
is the stress that in loco research can cause in interventions and guidelines for new building
environments of this nature and also because of designs, based on procedures for managing
the implications of the negative aspects which environmental quality. Also, in the 1990s a few
might be found. large Brazilian cities came out with specific
guidelines for hospital designs. The city of Rio
For these reasons, few M.A.’s dissertations and de Janeiro, the second large Brazilian urban
Doctoral theses based on the POE applied to environment, was one of them.
hospitals have been concluded, and few other
studies have been published in this area by schools In this regard, the POE applied to the
of architecture and urbanism in Brazil. Those Orthopedics and Traumatology Institute of the
that have appeared are basically concerned General Hospital is of special significance, not
with flows and circulation (Kotaka; Fávero, only because of the importance of this public
1998), sustainability, environmental comfort, institution as a teaching hospital and the service
and functional aspects in general ((Visconti, it provides to the population, but also because
1999); (Del Rio; Ornstein; Rheingantz, 1998); the study consists of a virtually unprecedented
(Cavalcanti, 2002); (Sampaio, 2006)). The report POE, focused on questions of accessibility and
by Kohlsdorf (1995) might also be mentioned fire safety. For this study the authors sought to use
here, as it provides an important analysis of the multi-method and multi-technique approaches
morphological performance of hospital buildings aimed at guaranteeing the reliability of the entire
on the basis of performance evaluation. In research process. The result was a floor-by-floor
addition, it takes into account the potentials of discovery map that synthesizes the opinions
orientations, identification and the capacity for of users and specialists, diagnoses, laws and
stimulus which this type of architecture induces regulations, and pertinent proposals for solutions
in people. More recently, Castro, Lacerda and whenever appropriate.
Penna (2004) made advances in the systematic
application of POE tools in buildings related to Accessibility and Fire Safety
health care on the campus of the Oswaldo Cruz In Brazil, as well as in other places in the world,
Foundation (Fiocruz) in Rio of Janeiro, including accessibility – meaning the existence of
demonstrations of a diagnosis resulting from the democratic venues that can be made use of
use of so-called discovery maps, described by by anyone, regardless of any physical, sensorial
Zeisel (2006) and by a group of researchers in the or cognitive limitations – consists of a process
Graduate Program in Architecture (ProArq) of that is implemented in a sequence of stages.
the Faculty of Architecture and Urbanism of the The process begins with the perception of the
Federal University in Rio of Janeiro (FAU-UFRJ), need to ensure social inclusion, followed by
coordinated by Dr. Paulo Afonso Rheingantz. decisions to put it into practice. Next, specific
Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

15
social measures must be taken based on providing information to architecture and

the realization that it is essential to structure engineering professionals at least partially

a legal framework that emphasizes equal bridging the gap caused by the failure to treat
opportunities. The process should also include such topics in Brazilian schools of architecture.
other less theoretical aspects concerning the
various technical areas.
The Case Study
Over the years, this set of measures and
processes gradually took shape through a series Description
of international guidelines that inspired specific The Orthopedics and Traumatology Institute
legislation in different countries. In Brazil, the first dealt with in this study was opened in 1953. It is
technical standards on accessibility in buildings generally referred to as the IOT and is a member
and spaces of public use, called NBR 9050, arose institute of the largest hospital complex in Latin
in 1985 and were revised in 1994 and 2004. America – the São Paulo General Hospital
[Hospital das Clínicas]. This complex is considered
Fire safety is a topic that has been studied since one of the most important centers in Brazil for
the early 20th century and has gone through producing technical and scientific information,
considerable scientific development since then, and is thus a center of excellence and reference
especially as a consequence of major losses in the field of treatment, education and research
caused by occasional but disastrous fires. In in the health care area.
Brazil, the first most significant measures were
taken only in the mid-1970s, after the occurrence The hospital complex itself was opened in 1931
of two major fires in high-rise buildings in the city and today it occupies an area of 340,000 square
of São Paulo. It can still be said today that the meters, with approximately 2000 beds, 36,000
laws and regulations currently in effect, which set surgeries, 1.2 million out-patient services, and
down the minimum conditions of fire safety in the 66,000 hospital admissions per year. It comprises
country, are scarce and often ineffective. thirteen health institutions, including nine
In addition, the lack of knowledge and hospitals, the School of Nursing, and the Faculty
concern among users of buildings makes the of Medical Sciences of the University of São Paulo
problem worse, because it results in deficiencies (USP), as shown in Figure 1.
generated by the lack of maintenance of the
protection equipment that is already in place The IOT was built to address the infantile paralysis
and by the lack of preparation of the public to epidemic (polio) in Brazil in the 1950s, and it
face emergency situations. provided all necessary orthopedic technology
at the time for treating this disease and its
In the last two decades, a number of technical sequels, although it treated fractures as well.
and normative documents have been published Built on the model of modern architecture, it
in relation to both accessibility and fire safety. consisted of eight above-surface floors and an
Academic work has also played an important underground floor, providing a total of 20,000
role in publicizing these areas of knowledge, square meters of built area with capacity for 300

16
beds and 400 rooms (1). Currently the IOT has divided into Wings A, B, C, and D (see Figure
25,000 square meters of built area comprising 2). Wings A and B are symmetrical, with eight
seven specialized laboratories, 890 employees, floors interconnected by a central lobby called
3,500 clinical consultations, 4,500 emergency Wing C, where the elevators and stairways of
cases and 500 surgeries per month and a clinical common use for Wings A and B are located.
staff of over 200 physicians. With the eradication Wing D currently houses the biomechanical
of polio, the institute began addressing demands laboratory, experimental surgery, animal
for treatment, research and education related laboratory and the prosthesis shop, and includes
to other major orthopedic pathologies and the basement floor, a ground floor and two
disorders. higher floors. The Annex Building was designed
and built later to address the need to expand
Nonetheless, the building retains many
the institute’s services and facilities. The first stage
characteristics of style, construction structure
of the Annex was concluded in 1972 and the
and volume that were virtually original at the
second in 2005.
time it was built. Its floor plan in “T” format is
1 – FACULTY OF MEDICAL SCIENCES OF UNIVERSITY OF SÃO PAULO 8 - CHILDREN’S INSTITUTE (ICR)

(FMUSP) 9 - TROPICAL MEDICINE INSTITUTE
2 - HEART INSTITUTE (INCOR) 10 - FORENSIC MEDICINE INSTITUTE
3 - REBOUÇAS CONVENTION CENTER 11 - NUCLEAR MEDICINE INSTITUTE
4 - OUTPATIENT BUILDING (PAMB) 12 – MEDICAL RESIDENCE
5 - CENTRAL INSTITUTE (IC) 13 - ADMINISTRATION BUILDING
6 - RADIOLOGY INSTITUTE (INRAD) 14 - ORTHOPEDICS AND TRAUMATOLOGY INSTITUTE (IOT)
7 - SCHOOL OF NURSING 15 - PSYCHIATRY INSTITUTE
Figure 1: Schematic Drawing of the General Hospital Complex of the Faculty of Medical Sciences of University of São Paulo.

17
Figure 2: Schematic Drawing of the IOT Building and its Uses by Floor.
Evaluation Methods and Techniques the decisions and who are not familiar with the
The present study began with a planning stage, matters at issue. The flowchart of the process is
which included the organization of the teams, presented briefly in Figure 3.
scheduling of visits, scheduling and distribution
of tasks, reconnaissance of the space, contact Results of Post Occupancy Evaluation
with key people, authorizations, walkthroughs,
data gathering, annotations, drawing up of Diagnosis of Physical Performance
questionnaires, photographic records, physical The IOT building has undergone several
measurements, structured and semi-structured adaptations in the area of access, such as in
interviews, and focus groups. Quantitative and some restrooms and certain ramps and parking
qualitative studies were combined in order to places, but they have not always complied with
expand the results. the standards provided in the standard currently
in effect, namely, NBR 9050: 2004 (ABNT, 2004).
At the end of the process all results were shown
on the discovery maps, also referred to by In general, the areas of circulation, access
Zeisel (2006) as discovery matrixes, as a way doors, admittance and surgery areas, as well as
to synthesize and visualize the diagnosis, the elevators, have dimensions that enable persons
recommendations and the pertinent standards in wheelchairs to maneuver or be maneuvered.
and regulations, thus identifying the points that However, problems were found with the
require interventions of short (most critical), stairways, with inadequate dimensions, railings
medium or long term. This representation had the and floors, and the absence of visual or tactile
main objective of facilitating the understanding signs. In some environments of restricted use,
and reading of the results by those who will make access is hampered by narrow or heavy doors,

18
Figure 3:
Flowchart of
the Process for
Developing a
Post Occupancy
Evaluation (POE)
Mechanism.
door handles that are difficult to manage, and installations that are not sealed off.
poorly arranged furniture.
The side stairways (located at the end of Wings A
The building’s characteristics of construction and B, as can be seen in Figure 2) cannot be used
and use classify it as having low likelihood for as escape routes because they are not enclosed
fires to begin or spread because there is little either. Access to them is obstructed by glass
accumulation of flammable material and doors, they do not have the proper dimensions
adequate building and finishing materials are and the proper directional signs in place, and
used in the circulation and admittance areas they discharge one floor above the exit to the
(floors and walls). However, the emergency ground floor. The essential fire safety equipment,
exits for vertical circulation were indicated as such as extinguishers, hydrants, manual alarms
being hazardous for the occupants because the and emergency lights, is duly installed, but there
building has an open central stairway (Wing C) were no records of regular inspections and tests.
that would allow the propagation of gases and The building has no automatic sprinkler system or
smoke. The same is true for the shafts of building fire detectors, due to the fact that only recently

19
have building codes begun requiring such carried out, aspects which would probably not
equipment in this type of occupancy. be noticed otherwise. The opinions expressed

in the two focus groups held with nurses were
Verification of Users Satisfaction compatible with the technical opinions of the
The diagnosis made by the researchers was not researchers. The groups also cleared up doubts
always confirmed by the users in their responses as to the functioning and use of the spaces. The
to the questionnaires. This ambiguity is frequent, unstructured interviews held during the study
possibly due to a wide range of factors, such as were also very important. A part from indicating
lack of information by the users about the topic problems that were not perceived in the first
approached, superficial observation of the collection of data, they enabled the observation
space, different levels of involvement with the of the everyday life of the various categories
location, and possible defects in the structure of of users who work there, and produced
the questionnaire itself. opinions that contributed to the analysis of the
questionnaires.
Structured interviews enabled the detection
of more specific aspects related to the use of Results
the spaces and factors regarding the activities The results in the final report (Gill et al., 2005),
Figure 4: Example of Discovery Map (Floor plan of the 2nd Floor of the IOT). Figure 5: Section of the Discovery Map
for the Second Floor of the IOT Building.

20
FLOOR LOCATION FOCUS RESULTS OF THE METHODS AND TECHNIQUES APPLIED IN THE DEGREE OF PROPOSAL OBSERVATIONS
RESEARCH IMPORTANCE
Walkthrough Interviews /
questionnaires / focus
Problems Technical groups
Detected standards to be
complied with
2nd Central Accessibility Absence of NBR 9050 The signs in the central Low A sign pointing to Wing Although this
Hallway directional (Item 5.5), hallway of the IOT were A should be placed at question shows
signs which provides classified as Very good this location. The sign a low level of
indicating a number of and Good by most of should also indicate in importance it
the infirmary recommend- the nurses and students detail the type of activity can be easily
in Wing A ations to be interviewed (See Graphs conducted there solved.
followed 1 and 2 in the Discovery (important information
regarding Map of this floor). for visitors). The signs
visual signs should also be available
in Braille, and the format
of the sign (colors and
dimensions) should
comply with Technical
Standard NBR9050
(Item 5.5).
There is NBR 9050 ---- High Place visual and tactile -----
no sign (Items: 5.13; alert and directional
indicating 5.14.1.2, signs near the stairway
the location Figure 63;
of the 5.14.2), which
central recommend,
stairway respectively,
the presence
of visual signs
for steps, tactile
alert signs
on the floor,
and tactile
directional
signs on the
floor
Central Fire safety Central IIT No. 11 Whereas most of the High Place a handrail with The central
Hallway stairway (Item 5.8.2.1) nurses interviewed 2 heights (0.70 and stairway is not
has a low São Paulo considered the situation of 0.92m) along entire classified as an
protective City Building the railings in the central extension of the escape route in
railing Code (Section lobby (= the central Central stairway. It case of fire, as it
(h=0.97m 12.3.3.1), stairway) as Very bad, should be easy to hold is not enclosed
while the which contains most students considered (4.5mm). and could cause
technical recommend- it Good or Regular (See accidents in
standard ations “Appendices,” Graphs a fire situation
establishes regarding 3 and 4 on the Discovery (many people
h=1.05m) hand-railings Map for this floor). In an going down the
and there and protection interview, maintenance stairway quickly),
is no railing ratings. employees of the IOT because the steps
in some informed the researchers are slippery, the
sections. (stated in the interview vertical span is
as the reason for the completely open,
conditions of the stairway) and there are no
that most people who use handrails.
this central stairway move
slowly, as they are users
with difficulties, such as
elderly patients or persons
with physical handicaps.
Table 1: Example of Synthesis of Results (Diagnosis and Recommendations) - 2nd Floor (partial).

21
summarized in tables, and allowed an initial and recommendations proposed. It can

visualization of the situation through one or more be seen that many more aspects regarding
tools and techniques of the POE. One example accessibility were detected than those related
is presented in Table 1, where a given degree of to fire safety. However, the priority given to
importance (low, medium or high) is attributed fire safety is proportionally higher than that
to each aspect in terms of the degree of priority given to accessibility. This situation is perfectly
for implementation. Discovery maps were drawn understandable as problems related to fire safety
up based on the contents of these tables, as are not usually specific for the various floors, but
exemplified in Figures 4 and 5, which constitute a rather a characteristic of the building as a whole,
graphic synthesis of the research results. in contrast to questions of accessibility, which vary
from one specific place or situation to another.
Table 2 shows the number of evaluations
Place Focus Degree of Frequency Place Focus Degree of Frequency

Importance Importance
Surrounding Accessibility High 4 Fire Safety High 1
Area
Medium 0 Medium 0
Low 0 Low 0
Fire Safety High 0 2nd Floor Accessibility High 26
Medium 0 Medium 43
Low 0 Low 17
Basement Accessibility High 3 Fire Safety High 11
Medium 0 Medium 3
Low 0 Low 0
Fire Safety High 1 3rd Floor Accessibility High 21
Medium 1 Medium 31
Low 0 Low 11
Ground Floor Accessibility High 4 Fire Safety High 13
Medium 4 Medium 1
Low 1 Low 0
Fire Safety High 1 4th Floor Accessibility High 21
Medium 0 Medium 35
Low 0 Low 18
1st Floor Accessibility High 1 Fire Safety High 11
Medium 1 Medium 2
Low 0 Low 0

22
Place Focus Degree of Frequency

Importance
5th Floor Accessibility High 4
Medium 2
Low 5
Fire Safety High 7
Medium 6
Low 0
Medium 4
Low 4
Fire Safety High 7
Medium 6
Low 0
7th Floor High 6
Medium 5
Low 0
High 2
Medium 7
Low 0
Medium 1
Low 1
Fire Safety High 11
Medium 2
Low 0
Total Accessibility High 99 (35%)
Medium 126 (45%)

Figure 6: Users’ satisfaction level regarding access points:
Low 57 (20%) The graph shows an example of results obtained (average

Fire Safety High 65 (70%) values in a score from 1 (bad) to 5 (excellent)) from applying
the questionnaires incorporated into the discovery maps, and
Medium 28 (30%) they clearly complement and corroborate the information
gathered from the users’ opinions.
Low 0 (0%)
Table 2: Quantitative Synthesis of the Evaluations, with their

Respective Priorities.

23
Final Considerations worldwide during the 20th century, but in Brazil

the topic was first included in the São Paulo City

Methodological Procedures Building Code only in 1975, and the first São Paulo
As a result of this study, the authors consider State Fire Safety Regulations were issued by the
that the methodological procedures of the POE Fire Department only in 1983.
addressed to the quality of management of the
designing process in hospital buildings should The accessibility became a requirement in
include the following stages: building regulations and codes in Brazil in
1980, but with isolated laws and segmented
During the pre-test stage, analyze all possible
approaches. Only in 1992 did the legislation
shortcomings inherent to the application of the
become more demanding and consolidated,
POE in a hospital where users are constantly
with the São Paulo City Building Code, for
subject to varying levels of stress;
example, which required compliance with
Planning of the application of the POE and the Brazilian Technical Standard NBR 9050: 1985,
intended results; regarding the adaptation of buildings and
spaces for handicapped persons.
Development of solutions arising from the results
of the POE, through architectural designs, Several difficulties had to be faced in order to
design of furniture and equipment, and visual effectively adapt the spaces of the IOT building,
communication; due to its physical complexity and questions
related to public management – which requires
Definition of how the results visualized on the
specific institutional measures to be backed
discovery maps can be presented to and
up by the existence of financial resources
discussed with the community of users, thus
for carrying them out and maintaining them.
leading to subsequent truly collective designs;
Nonetheless, this study has shown that such
Definition of procedures to guarantee that implementation is possible, provided that it is
discovery maps are applied regularly and carried out in stages according to an order of
continuously to feed a databank (with diagnoses priorities (high, medium and low) and, especially,
and solutions) based on POEs with the purpose of with the involvement of its managers and
managing quality in the designing process; employees, and that of the community, through
clear proposals, open discussions of ideas that
Verification of the possibility of using the solutions culminate in a collectively drawn up project.
shown on the discovery maps as benchmarks
or references of quality in other hospital The authors believe that, through the research
environments. carried out at the IOT building, it was possible
to demonstrate the ways by which proposals
Quality of the Management of Designs in for the needed interventions in hospitals can be
Hospitals in Brazil evaluated and presented. Such an evaluation is
Technological advances and more regulations particularly important in public hospitals, where
in the area of fire safety took on greater visibility processes of identifying problems, establishing

24
priorities for interventions and obtaining financial “Instituting internal mechanisms of self-evaluation
resources are usually dissociated. By carrying and continuous refinement of the quality of
out a POE, these aspects can be more easily the medical treatment provided by hospitals”
combined, creating synergy that will facilitate (Novaes, 1999: 07).
management and foster a better environment
for the hospital’s employees and users. Mechanisms such as the Hospital Accreditation
Program create a procedure of self-evaluation in
It was also seen that, in the case of hospital consonance with the objectives of the POE, and
buildings and similar architectural designs (such can be used in conjunction with it in the effort to
as day hospitals, diagnostic units, emergency improve the quality of use, circulation, treatment
facilities, etc.), it is important and effective and safety of the complex.
to apply the POE focused on the topics of
accessibility and fire safety, which often overlap References
in terms of problems and solutions.
ABNT - Associação Brasileira de Normas Técnicas.
Therefore the authors see excellent opportunities NBR 9050 Acessibilidade a edificações, mobiliários,
for expanding this POE methodology to the entire espaços e equipamentos urbanos. 2004. Available
complex of the São Paulo General Hospital. In at: http://www.presidencia.gov. br/sedh/corde.
fact, this process has already begun through Bechtel, R. B. (1997). Environment & Behavior: An
a second case study, this time involving the Introduction, Sage Publications, Thousand Oaks,
Psychiatry Institute (IPq), also located at the California, USA.
General Hospital (GH) campus. Due to the size of
Castro, J.; Lacerda, L.; Penna, A.C. (Org.). (2004).
the GH complex, and for the POE to be effective Avaliação Pós-Ocupação. Saúde nas Edificações
in producing of long-lasting results, it is likely that da Fiocruz, Fundação Oswaldo Cruz, Rio de Janeiro,
the best solution would be to prepare a group of RJ, Brazil.
professionals from the GH to systematically apply
this methodology so that periodic evaluation Cavalcanti, P. B. (2002). Qualidade da Iluminação
of the buildings and open areas around them em Ambiente de Internação. Programa de Pós-
become systematic and routine events. Graduação em Arquitetura da Faculdade de
Arquitetura e Urbanismo da Universidade Federal
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(unpublished master’s thesis).
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should be also beneficial for implementing the Del Rio, V.; Ornstein, S.W.; Rheingantz, P.A. (1998).
proposed culture of evaluation. In addition, in the “Avaliação Pós-Ocupação (APO) walkthrough
case of Brazil, the Hospital Accreditation Program da Clínica São Vicente, RJ: experiência didática,
could become a mechanism for refining the POE metodologia e resultados”, In: ENTAC 2000
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Nacional de Tecnologia do Ambiente Construído,
is that of “Improving the quality of treatment
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Gill, A.A.; Cardoso, E.C.; Silva, E.C.S.; Machry, H.S.; Sampaio, A.V.C.F. (2006). Arquitetura Hospitalar:
Peres, R.F.; Monteiro, R.Z.; Barretto, R.E.; Gomes, Projetos Ambientalmente Sustentáveis, Conforto
S.H.T. (2005). Projeto Hospital Legal- IOT Clínicas: e Qualidade: Proposta de um Estudo de Avaliação.
Avaliação Pos-Ocupação do Instituto de Ortopedia São Paulo: Faculdade de Arquitetura e Urbanismo
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Faculdade de Medicina da Universidade de São (unpublished PhD thesis).
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em acessibilidade e segurança contra incêndio, São Visconti, M.G. (1999). Programação de Projetos
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Urbanismo da Universidade de São Paulo, São Paulo,
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Estabelecimentos Assistenciais de Saúde, Brasília, DF, Landscape, and Planning,W.W.Norton & Company,
Brazil. Inc., London, UK.
Kotaka, F.; Fávero, M. (1998). “Avaliação Pós-

Ocupação em Hospitais: considerações sobre sua
Notes
(1) Information available at the website of the
aplicação”, In: NUTAU’98 - Arquitetura e Urbanismo:
General Hospital Complex of the Faculty of Medical
Tecnologias para o Século XXI. São Paulo: NUTAU-
Sciences of University of São Paulo: www.hcnet.usp.br
Núcleo de Pesquisa em Tecnologia da Arquitetura
[August 10, 2006].
e Urbanismo da Universidade de São Paulo, São
Paulo, SP, Brazil, (Proceedings in CD Rom).
Acknowledgments
Novaes, H.M. (1999). Manual Brasileiro de The authors are grateful for the valuable cooperation
Acreditação Hospitalar. Secretaria de Políticas de of the management of the Orthopedics and
Saúde, Ministério da Saúde, 2nd edition, Brasília, DF, Traumatology Institute of the São Paulo General
Brazil. Hospital for providing the research team with this
special opportunity for study, and for the efforts made
Preiser, W.F.E.; Vischer, J.C. (Eds). (2005). Assessing
by Mr. Tomaz Puga Leivas in putting the research
Building Performance, Elsevier, Oxford, UK.
project into practice. The coordinator of this study, Dr.
Preiser, W.F.E. (1998). “Health Center Post- Sheila Walbe Ornstein, offers her thanks to the National
Occupancy Evaluation. Towards Community-Wide Scientific and Technological Development Board
Quality Standards”, In: NUTAU’98 – Arquitetura (CNPq), as a scholarship holder of this institution. The
e Urbanismo: Tecnologias para o Século XXI. São authors also cannot fail to thank the other members of
Paulo: NUTAU-Núcleo de Pesquisa em Tecnologia the teams that cooperated in this study, especially the
da Arquitetura e Urbanismo da Universidade de São architects E.C.Cardoso, E.C.dos S. Silva, R.F.Peres, R.da
Paulo, São Paulo, SP, Brazil (Proceedings in CD Rom). E.Barretto and S. H. T.Gomes.
Roméro, M.A.; Ornstein, S.W. (Eds.). (2003).

Avaliação Pós-Ocupação. Métodos e Técnicas
aplicados à Habitação Social. Associação
Nacional de Tecnologia do Ambiente Construído.
Coleção Habitare, Porto Alegre, RS, Brazil. [http:
//habitare.infohab.org.br/]

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Article in International Journal of Architectural Research · March 2007

Sheila Ornstein Rosaria Ono

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Anni Gill Herminia Machry

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HEALTH CARE ARCHITECTURE IN SÃO PAULO, BRAZIL:

Sheila Walbe Ornstein, Rosaria Ono, Maria Elisabete Lopes,

Copyright © 2007 Archnet-IJAR, Volume 1 - Issue 1 - March 2007 - (13-25)

Archnet-IJAR, International Journal of Architectural Research

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

social measures must be taken based on providing information to architecture and

the realization that it is essential to structure engineering professionals at least partially

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

1 – FACULTY OF MEDICAL SCIENCES OF UNIVERSITY OF SÃO PAULO 8 - CHILDREN’S INSTITUTE (ICR)

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

equipment in this type of occupancy. be noticed otherwise. The opinions expressed

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

summarized in tables, and allowed an initial and recommendations proposed. It can

Place Focus Degree of Frequency Place Focus Degree of Frequency

Fire Safety High 0 2nd Floor Accessibility High 26

Basement Accessibility High 3 Fire Safety High 11

Fire Safety High 1 3rd Floor Accessibility High 21

Ground Floor Accessibility High 4 Fire Safety High 13

Fire Safety High 1 4th Floor Accessibility High 21

1st Floor Accessibility High 1 Fire Safety High 11

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Place Focus Degree of Frequency

Fire Safety High 7

6th Floor Accessibility High 5

Fire Safety High 7

7th Floor High 6

8th Floor Accessibility High 4

Fire Safety High 11

Total Accessibility High 99 (35%)

Medium 126 (45%)

Low 57 (20%) The graph shows an example of results obtained (average

Table 2: Quantitative Synthesis of the Evaluations, with their

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Final Considerations worldwide during the 20th century, but in Brazil

the topic was first included in the São Paulo City

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

Kotaka, F.; Fávero, M. (1998). “Avaliação Pós-

Roméro, M.A.; Ornstein, S.W. (Eds.). (2003).

Archnet-IJAR, International Journal of Architectural Research - Volume 1 - Issue 1 - March 2007

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