hospital designing and planning

7/31/2019 Hospital Designing and Planning

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DR. D .H. SUKHWAL

HOSPITAL DESIGNING

& PLANNING


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To build a hospital that isfunctional, efficient and yet

economical withoutcompromising on the design

aspect

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Objectives

Provide a functional design thatensures efficient, safe and

appropriate work space. Accommodate technical

requirements for highly sophisticatedequipment.

Create clear, segregated paths formovement of people and materialwithin the building.

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Objectives..

Create a humane environment forpatients and staff.

Develop building systems that canaccommodate rapid change.

Blend technical and functional

requirements into a design thatbrings delight to those who use thebuilding and those who pass by it.

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STEPS

Decision to build the hospital

A detailed architects brief

Architect drawing up his plans withconsideration of landscape, facility mix, bedmix, availability of utilities in the vicinity

Inputs from other agencies like air-conditioning, electrical, plumbing, etc.required to finalize the working plan for thebuilding

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Inputs from the equipment vendorsespecially in specialty areas like Cath-labs, CT-scanners, MRI, linear

accelerators, operation theatres etc.essentialEmphasis to be given to support services

like kitchen, laundry, CSSD, back-up

electricityShould be properly planned: Vital

services with high capital costs &

recurrent expenses 6


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Planning & Design Team

Functional complexities in hospitals

are more than physical complexities;

so we require persons whounderstand not only the work processof individual departments but those

of the hospital operating system as awhole

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Planning & Design Team ..

Required: analysis of functionalneeds, understand

interrelationship of departments,area requirements, major

equipment, the grouping ofaccommodation and the mainoutline of traffic flow

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Standards followed

India: total area per bed is hardly

600 sq. ft. Western standards: 1,400 2,000 sq.

ft. per bed

WHO recommends an area of 800-

1200 sq. ft per bed

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Functionality is a prime

determinant of operationalefficiency in the total life

cycle cost of all hospital

structures

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..

Functions

Locations

Relationship

Utilization

Functional planner is a trained

hospital administrator who is capable ofinterpreting complex relationships,internal traffic flows (personnel and

supplies)11

Staffing pattern

Space requirements

Work flow


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.. Technological requirements Operational procedures Product of beauty Reasonable cost Optimal utilityA functional design: promotes skill, economy,

conveniences & comforts.A nonfunctional design: impedesactivities ofall types, detractsfrom quality of care &

raisescosts

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functional planner

With Architect :

Physical evaluation of existing facilities

Space programming

Master site planning

Functional evaluation of existingfacilities

Preparation of workload projections

Functional programming

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Space programming

Based on functional program amended &approved by hospital a room by roomlisting is made of all areas in proposedproject

Net square footage is assigned to eachspace, & totals accumulated for everydepartment or functional entity using net

figures Appropriate calculations are then made to

set gross totals for each department or

functional entity as well as the total forentire ro ect 15


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Preparation of workload projections

Functional planner determines &formulates concepts of operation forproposed project according to previous

study findings. These concepts are incorporated in

functional program

These projections form the basis forfunctional programming, revenueprojections & staffing estimates

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Functional programming

Formulating recommendations for operationalconcepts

Detailed room composition of project, required

phasing, alterations, internal & external trafficflows, interdepartmental relationships &operating systems

Using approved recommendations & findings ofstrategic plan, findings of physical & functionalevaluations & workload projections, functionalplanner formulates the activity

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Written program explaining theabove requirements

With this written programs help,architect prepares schematicdrawings and sketch plans

Helps the architect to build afunctional, economical and efficienthospital.

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contains ..

Permission required from variousregulatory bodies

Spatial needs of various departments

Manpower required

Special requirements of various

departments Inter and intra departmental

relationships 20


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Flexibility for future expansion

Larger secondary areas for better

patient comfort Proper utilities for waiting areas

Nurse stations Storage

Changing rooms21


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Alcoves for stretchers/ wheelchairs Adequate transport facilities

Parking facilities

Proper light and ventilationTime & trouble spent during this

stage will be well repaid & enablewhole project to proceed smoothlywith minimum subsequent revision

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To primarily know the deficiencies in thehealth care market, so that we can decide

proper facility & bed mix

To help us finalize size of the project

For existing hospitals to undertakebenchmarking in areas like tariff

rationalization, compensation policies,

utilization reviews for various services etc.

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Households Medical professionals

Diagnostic centers

Nursing homes

Hospitals

Relevant data from census report,demographic surveys, government/

media publications etc.

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Brief description on major findings ofmarket research

Proposed facilities plan

Detailed project cost: land & building,medical & non-medical equipment,

furniture & fixtures, utilities, pr-operative

costs, contingencies, working capitalrequirement, means of finance

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Income and expenditure projectionsbased on the feedback from the

market research and availabledatabase

Profit and Loss/ Balance sheet/Cash

flow statements Break even analysis

Sensitivity analysis 26

Feasibility...


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Specialized healthcarearchitecture

Healthcare architecture requiresspecialized knowledge on part of architect& supporting engineering team

Stringent functional demandsImproves quality of environment for

patient & caregivers

Meets needs of people using suchfacilities in times of uncertainty, stress, &dependency on doctors & nurses

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Recognize & support patients' families &

friends by providing pleasant spaces

Project an underlying reassurance thatpatient is in hands of competent medicalstaff & in a technically sound healthcare

facility Convenience, caring encounters, service

orientation and quality of care

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Specialized healthcare

architecture..


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Project Management

Liaison with all Agencies -Architects/contractors/equipmentvendors/utility service consultants and suppliers

Monitoring Project with PERT/CPM Managing Change in Project Plans - most vital &

complicated component due to various fall outsfrom change in project design

Managing equipment planning scheduleincluding cost-feature analysis, procurementprocess, installation etc.

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Project Management..

ArchitecturalDesigning

Project

ManagementTurn AroundStrategies

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Operational Audits:o Improvement of the lab

serviceso Operation theatre

utilization reviewso Manpower auditso Medical auditso Infection control programso Reorganization of profit

centerso Support service audits etc.


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Product Development

Benchmarking regarding market expectationfrom a hospital management system

Hospital best practices

Reviews of newer modules and upgradeversions and provide recommendation of anyenhancements/modification

Periodic comprehensive review and study of theexisting modules to update and upgradecontinuously

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Implementation

Implementation plan with solution A comprehensive system study

Gap analysis

Preparing specification for customization Site monitoring

Audits of the sites where software is already

installed to identify areas of problem Business development in terms of

identifying new leads, identify right businesspartner

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real test of any hospital is: quality of

healthcare it provides

minor defects in designing could makeoperation of a hospital inefficient

inefficient hospital costs significantly

more to operate staff & maintain:patients within it get less health

services for money they pay

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The initial cost of building a hospitalis insignificant when compared to

the cost of running and maintainingit over the years-

by one reckoning eighteen to

twenty times over a period of

twenty years

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Efficient, Functional andeconomicAl hospitAl


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Another study says that running cost of ahospital over 4 to 5 years from the date ofcompletion is about the same as the capital

cost

if the facilities are not planned & designedproperly the intangible cost can be enormous

efficiency with which physicians & theirassistants can function is greatlyhandicapped by obsolete design

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Patient comfort & provision for expansion is oftenoverlooked.

Growing efficiency & innovative ideas haverevolutionized hospital building construction to

meet special needs of patients

A pleasant environment that makes forenthusiastic & more productive staff also

benefits patients indirectly

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Many patients complain that hospitalsreduce privacy, individuality & more

importantly human dignity. Many of

these details & facilities can beincorporated with little or no extra cost.

So, patients needs & expectations

should be kept uppermost in mind & any

design should aim at his satisfaction &comfort

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These factors are again influencedby rapid changes and advances

that are taking place in fields oftechnology & medicine &constant need to modernize,

renovate, replace & expandhealthcare facilities

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A common understanding is required between; ON ONE HAND: ARCHITECT & ENGINEERS

ON OTHER HAND: PROMOTERS, DOCTORS,ADMINISTRATORS & PLANNERS

Next step is operational plan for each departmentto decide;

LOCATION of each department, requirement ofFLOOR SPACE, intradepartmental &interdepartmental RELATIONSHIPS, CIRCULATION,TRAFFIC FLOW and requirements IN RELATION TOequipment, personnel & patients

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Operational planning is a written documentfor any architectural project:- Services,number of beds, departmental functions,

departmental needs, major equipment, spacerequirements, required personnel,relationships and adjacencies are includedhere.

Dept-by dept description of needed space current and projected needs within the

facility

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Normally there is either no briefing of thearchitects or the brief given to him is inadequate

They are asked to prepare building schedules with

the help of doctors OR Observe other hospitals & take guidelines from

them. Both these are unsatisfactory methods.

Promoters must clearly tell architect therequirements of hospital & not the other way

round

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The proper sequence is;First: Develop operational planning that

defines major requirements & needs.

Next: Operational plan is developed into afunctional plan i.e. planning of thehospital on a functional basis-that lists

every room & suggests net sizes for majorfunctional rooms &total size of thedepartment.

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Functional grouping of high traffic areassuch as X-ray, laboratories, surgical & deliverysuites, physical therapy & clinics on two floors isdesirable

It permits concentration of hospital activities in amanageable unit.

When future expansion or change becomesnecessary, they can be accomplished withoutdisturbing other areas

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Operational Plan & Functional Planmust precede Architectural Plans

Otherwise; Within 510 years, it is found that cost

of construction equaled or surpassed

by operating expenses

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Hospitals must be planned forfuture

A fundamental rule is; hospital should beplanned for at least 10 to 15 years ahead orelse plans will be obsolete

Well planned systems must be built tokeep pace with the changes

`Smart` hospitals that respond to presentneeds while anticipating future change;should be built

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All departments are planned in such a way thatthey stand out individually

Each department with space around for

expansion. Future expansion is rendered easy with free

ended buildings with extendable corridors

Expensive permanent fixtures & fixedequipment such as plants & elevators are notlocated at free ends of the departments as they

would permanently block expansion plans 48


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Space Plan

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Architect finalizes his plans, with help of;

personal interviews with hospital administratorsexperienced in building hospitals

literature reviewFor a 100 bedded hospital, total space area

including the parking space, HVAC & wateris 1,05,319 sq ft which works out to be

9784.45 sq meter.Modern standards of constructing hospitals

requires; 800-1200 sq ft per bed.

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First floor

Administration department

Blood bank

General and Pediatric wards

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Second floor

Labour room

Obstetric ward

NICU Semi-private ward

CSSD just below the operation

theatre with provision for dumbwaiters between the CSSD and the OT

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3rd floor

ICU

Private wards

OT

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4th floor

Residential area just above ICU &

OT. So a doctor can easily attend

the patient when called

30% of the area is kept for

circulation

hospital designing and planning

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