essentials of hospital planning.docx

7/25/2019 essentials of hospital planning.docx

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Definition of a Hospital

Hospital derived from latin word hospitalis which comes from hospes,meaning a host.

Hospital comes from French word hospitale(like hostel & hotel) an establishment for

temporary occpation by the sick and the in!red

"# hospital is an instittion which is operated for the medical$ srgical and%or obstetrical care

of inpatients and which is treated as a hospital by the 'entral%state government%local

body%private and licensed by the appropriate athority

irectory of Hospitals in *ndia$ +,--

# hospital is an integral part of a social and medical organiation$ the fnction of which is to provide

for the poplation complete health care$ both crative and preventive$ and whose otpatient services

reach ot to the family and its home environment$ the hospital is a centre for the training of health

workers and biosocial research.

-WHO definition of Hospital

/ssentials for good Hospital planning

High Quality Patient Care

0atient care of a high 1ality shold be achieved by the hospital throgh2

0rovision of appropriate technical e1ipment and facilities and competent professional and

technical staff to spport the hospitals patient care ob!ectives.

#n organiational strctre that assigns responsibility and re1ires accontability for thevarios fnctions within the instittion.

# continos review of #de1acy of care provided by physicians$ nrsing staff$ and

paramedical technicians and the ade1acy with which patient care is spported by other

hospital activities.

Effective Community Orientation

# governing board made p primarily of persons who have demonstrated concern for the

commnity and leadership 1ality.

0olicies that assre availability of services as needed to all the people in the hospital servicearea.

0articipation of the hospital in commnity programs to provide preventive$ emergency$ and

casalty care.

# pblic information system that keeps the commnity informed abot and identified with the

hospitals goals$ ob!ectives$ and plans.

Financial Viaility

# corporate organiation that accepts responsibility for sond financial management with aview on optimm 1ality of care.


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0atient care care ob!ectives that are consistent with pro!ected service demands$ availability of

operating finances and ade1ate personnel and e1ipment.

# planned programme of e3pansion based solely in demonstrated commnity need.

# specific$ planned program for capital financing that will assre appropriate replacement$improvement$ and e3pansion of facilities withot ptting brden on patient charges.

#n annal bdget plan to keep pace with modern medical and hospital 0ractices.

Orderly Planning

#cceptance by the hospitals administrator of primary responsibility for both short and long

range planning$ with spport and assistance from competent financial$ organiational$

fnctional$ and architectral advice.

*dentification of the hospitals service area and other healthcare resorces.

#nalysis of the hospitals medical staff and nmber of patients admitted in the last three years

as the basis for pro!ecting admission trends of ma!or clinical service.

/3amination of se of ma!or clinical service departments$ and sch spportive service

departments for making a ftre pro!ection for each of these departments.

/stablishment of short and longrange planning ob!ectives with a table of priorities and target

dates on which sch ob!ectives may be achieved.

0reparation of a financial program that describes the short range ob!ectives to be achieved and

the facilities$ e1ipment and staffing necessary to achieve them.

! "ound !rchitectural Plan

4etention of an architect e3perienced in hospital design and constrction

5election of a site large enogh to provide for parking and ftre e3pansion and accessibility

to people.

etermination of facility sie appropriate to the pro!ected service demands of the hospitals

service area and of departmental areas large enogh to provide the diagnostic and treatment

services.

*mportance of establishing convenient traffic patterns both in and ot of the hospital for

movements of physicians$ hospital staff$ patients$ and visitors and for efficient transportation

of food$ landry$ drgs and other spplies.

#n architectral design that will permit efficient se of hospital personnel$ interchange ability

and fle3ibility in work areas.

#de1ate attention to important hospital concepts sch as infection control and disaster

planning.

4egionaliation of Hospital 5ervice


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ecentraliation by establishing levels of care.

6hree tier basis

4egional hospital hosp of entire geographical region$ complete range of

service radiotherapy$ nerosrgery$ thoracic srgery$ oncosrgery etc$associated with a medical college%post gradate teaching centre.

*ntermediate or istrict Hospital several hndred beds$ general hospital

providing medical$ srgical obstetrical and specialied treatment.

7ocal or 4ral Hospital 89 +99 beds$ ndifferentiated care general$

medical$ srgical and maternity care

6wo way flow of referral system & sharing of senior medical staff by consltant sessions and

reglar visits.

:ality of care & cost.

#evels of medical Care

#evels of care $edical facility #evels of decision ma%er

0rimary ispensary$ 0rimary Health 'entre or sbcentre ;0$ medical assistant$

mltiprpose worker

5econdary istrict Hospital( intermediate) or e1ivalent ;0$ partly specialist

6ertiary 0rovincial or similar hospital( regional) 5pecialists

:aternary *nstitte of 4esearch and higher training 5per specialists$

researcher

Hosp Planning &eam

efining re1irements people involved in direct tiliation & delivery of care e3perts inrespective clinical fields

Hosp administrator%


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4elationship between emand and =eed

Factors inflencing Hospital >tiliation

Hosp ?ed #vailability dev vs develop contries

0oplation coverage and bed distribtion

#ge 0rofile of poplation

#vailability of medical services other than hospitals

'stoms & #ttitdes of commnity & doctor fear admission$ early amblation.


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&opography' *deally$ the bilding is best located on relatively high grond in order to take

advantage of natral drainage.

#andscaping' 6he psychological effect of attractive gronds and srrondings on patient

welfare$pblic good will$ and staff morale cannot be nderestimated.

Ftre /3pansion

&otal Cost2 emphasis on total cost rather only initial cost of the bilding.

"ite "urvey' #fter selection$ provision shold be made for a srvey and soil investigation.

6his will help determine the type of fondation$ possibility of constrcting a basement$ and

effectiveness of sewage plant.


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A. 0ediatric bassinets & incbators in pediatric dept

?eds that are not inclded are2

+. ?assinets and incbators in maternity site.

A. 7abor room beds

8. @tpatient and 'asalty %emergency dept

D. ?eds in diagnostic depts like E ray or in ?lood bank

B. 4ecovery room

. =rsing hostel or staff residence.

G. #ny other which are not e1ipped and staffed for overnight stay

&ypes of 0ed !ccommodation

0rivate

5emiprivate

;eneral ards

;roped together 2 epartmentaliation of services for better tiliation of common

e1ipment and facilities.

?ed istribtion by service

6he distribtion of patients in a general hospital is e3pected in the range from2

medical 89 to D9 per cent$

srgical A9 I J

obstetrical +B+- per centJ

paediatric +9+A per centJ

miscellaneos and others (inclding eye$ ear$ nose$ and throat) +9+B per cent.

Factors influence 0ed Distriution'

+. =ew Hospital phasing by floor by floor $ wing by wing

A. Flctating censs allow interchangeability

8. /valation of needs$ services$ hospital policies$ staffing

"pace *e+uirements and *elationships

# master plan takes into consideration the ftre developments of the hospital$ however$ a ma!ormistake in forward planning is to attempt to meet pressre for beds$ which is sally dominant$ by


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adding them withot giving e1al consideration to spporting facilities. 6he master plan shold take

into #ccont the circlation rotes$ areas to be allotted to different departments$ ones$ compactness$

and also considering light$ wind$ hospital engineering$ and hospital hygiene aspects.

.

Distriution of Floor "pace

ards 2 8G DB I

@0 2 +A +- I

iagnostic 2 +- AA I

#dministrative 2 -+A I

5ervice epartment 2 +B A9 I

Circulation *outes

6he tility and sccess of hospital plans depends on the circlation rotes on hospital site and

within bildings. " ay finding " is a ma!or problem. 5eparate /ntrance and e3it for clarity &

secrity. *ndependent access for stores blk and transport of heavy dty or blky articles directly to

the point where it is re1ired. 6his cold be helpfl in case of bringing fire fighting e1ipment in case

of a fire. evelop flowcharts depicting movements of patients$ personnel and visitors for predicted

movements between departments and within departments.

*nternal 'irclation2

6raffic of patients$ staff$ employees and visitors$ as well as service deliveries$ the emergency

entrance.


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#void nde crisscrossing of patients$ staff$ spplies$ and visitors.

5eparate patient corridors and staff corridors to redce transit time.

Cisitors rote shold be controlled by visitors pass color coded

@tpatients roted from registration to sb waiting areas to lab and radiology dept. 6hey

shold not roted throgh inpatient.

5taff shold pass from entrance to locker rooms to place of pnching time%swipe cards

E3ternal circulation

D separate entrances

5eparate /ntrance ad!acent to kitchen and storage areas receiving blk spplies.


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'orridors of sie - feet by - feet.

alls to be smooth and not attract dst and dirt.

5taircase at least A in different areas of hosp fire e3its$ broad enogh for handling stretchers

in emergency.

/levators ma3 concentration of traffic. 5eparate pt and separate service elevators

;as for babies.

hen large continos spply of varios gases is needed$ two or more cylinders of the gas

are connected to each other and their common otlet is connected to a central piping system

throgh a control panel2


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Cery large glass overheating

#ir conditioning and air ventilation "#ir Hygiene is imp.

?asic principle that contaminated air from one part of the hospital is not transmitted to

another.

/nergy conversation & solar energy ;reen Hospitals

?ifrcation of areas ration of airconditioning

0uilding contract and Contract Documents

?ids for constrction.

7egally scrtinied before advertising and opened in person by the owner.

'ontract is normally given to the lowest bidder nless strong !stifiable reasons.

Furnishing 6 E+uipping the Hospital

8 types of e1ipment 2

+. ?ilt in /1ipment 2 fi3ed kitchen e1ipment$ elevators$ boilers$ walk in coolers$ deep

freeers$ srgical lighting etc.

A. epreciable e1ipment 2 /1ipment have a life of B years or more is not prchased throgh

constrction contracts. eg2 diagnostic and lab e1ipment$ 0harmacy e1ipment.

8. =on epreciable /1ipment2 less than B years span2 egJ srgical instrments$ linen$ kitchen

ware$ table ware$ chinaware$ lamps$ waste baskets etc.

#ctal ser involved in laying specifications


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6ime of appointment of staff is crcial.

/ach staff selection meticlosly done.

0roper orientation to staff.

6raining to staff.

'/@ to work closely with ept Heads on details and fnctioning of the

hospital.

etailed plan of action.

5hake own 0eriod 6rial 4n and appropriate evalation and corrective

measres.

Phasing

6he necessity to bring facilities into se as 1ickly as possible for operational reasons.

6he necessity to split a ma!or pro!ect into smaller nits of bilding work as a contractal

consideration.

6he necessity of having certain departments ready before others

7ocal priorities for introdcing services.

7imitation on availability of capital fnds.

Commissioning and 4nauguration

=eed not synchronie.

*nagration to inclde

0ress tor & 0ress conference

/laborate 0rogramme

/laborate tor to pblic by e3pert gides

#ttractive ?rochre

5ecrity for CC*0

0oo!a 'eremony.


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ithin a hospital environment there are mltiple departments with staff that are capable and

competent to provide cross coverage to other areas of the hospital where their e3pertise may

be tilied dring a large scale srge incident

/3ternal assistance is nlikely to be available to hospitals in sch national catastrophes

Floor area ratio(F!*) (also floor space ratio(F"*)$ floor space inde3(F"4)$ site

ratioand plot ratio) is the ratioof a bildingMs total floor area (gross floor area) to the sie of

the piece of land pon which it is bilt. 6he terms can also refer to limits imposed on sch a

ratio.

#s a formla2

Floor area ratio N (total covered area on all floors of all bildings on a certain plot$ gross floor

area) % (area of the plot) 6hs$ an F5* of A.9 indicates that the total floor area of a bilding is

two times the gross area of the plot on which it is constrcted$ as wold be fond in a

mltiplestory bilding.

F,!,*7 &otal floor area on the floors8Plot area
https://en.wikipedia.org/wiki/Ratiohttps://en.wikipedia.org/wiki/Ratiohttps://en.wikipedia.org/wiki/Gross_floor_areahttps://en.wikipedia.org/wiki/Gross_floor_areahttps://en.wikipedia.org/wiki/Ratio