Process of Planning,

Designing and Financing a

Hospital

Daniel Kelly, CEO

Overview

• Hospitals differ from other building types in the complexity of functional relationships that must exist between the various parts of the hospital.

• Apart from providing the right environment for patients and care providers, it should also be sensitive to the needs of visitors.

• It is thus imperative to examine the emerging issues, analyze the challenges, appreciate the emerging trends and study the various strategic options available for planning, designing and constructing a hospital.

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EMERGING ISSUES

1. Epidemiological and demographic

changes

2. Enhanced expectations of patients

3. Emphasis on ambulatory/ day care

4. Regulatory standards

5. Ever changing function of a hospital

6. Advancement in medical sciences

7. Trend toward outsourcing3

Schema of Building a Hospital

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STRATEGIC ESSENTIALS

• Issues that must be considered:

• Regionalization

• Needs assessment

• Design for flexibility and expandability

• Fulfill the demand functions

• Emphasis on patient focused hospital

• Focus on energy conservation

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IMPACTING FACTORS

• Community Profile

• Socio – economic

• Health

• Age

• Local regulations

• Source of finance

• Climatic zones

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STEPS IN PLANNING

Need Assessment

Feasibility Report

Architects Brief

Request for Proposal

Appointment of Consultant

Detailed Project Report

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STEPS IN PLANNING-cont.

Award of Work

Construction of Building

Equipment Purchase

Stage of Commissioning

Occupancy

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Feasibility Study

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PLANNING A HOSPITAL• Planning is the forecasting and

organizing the activities required to achieve the desired goals.

• All successful hospitals, without exception, are built on a triad of good planning, good design & construction & good administration.

• To be successful, a hospital requires a great deal of preliminary study and planning.

• It must be designed to serve people and for promoters to build in the first place & sustain later.

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Planning Team Make-up

• Hospital administrator• Specialists from various clinical

branches• Nursing Personnel• Civil and electrical engineers• Representative of local board• Senior architect

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HOSPITAL DESIGN

• The main guideline while designing the hospital is ‘FORM FOLLOWS FUNCTION’.

• All architectural and aesthetic design should be secondary in nature

• The design of the department should be according to the function of the department

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REQUEST FOR PROPOSAL

• Background of the project

• Architects brief

• Best practices in medical architecture

• Limitations

• Methodology and time frame

• Contract conditions

• Local regulations 13

ARCHITECTS BRIEF

• It is written document which explains the

operational policies, types of services

provided, inter relationships and

interdependency of each facility. It includes:

• Site information

• Functional content

• Workload

• Staffing

• Equipment14

ARCHITECTS BRIEF cont…

• Polices and procedure

• Schedule of accommodation

• Zoning

• Financial aspects

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Bed planning-

Bed: Population=A S 100

365 PO

A= number of inpatient admissions/1000 population/year

S= average length of stay

PO= percentage occupancy

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Planning of finances-

• Funds required for constructing, furnishing and equipping the hospital.

• Operating funds- salaries, loans and interest, other maintenance expenses.

• Arranging financial assistance-patient fees, bed charges, and other modes of revenue generation process.

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Project costing-• The most common method of estimating hospital

construction costs has been the “ per bed” method.• With a transition toward outpatient procedures the

current methodology is the cost per square foot. • Break up of project cost-

Acquisition of site Site survey, investigation Landscaping Construction contact-building with fixed equipment Supervision and inspection Equipping the hospital-diagnostic and therapeutic equipment Movable equipment, furniture etc. Architect's fee Consultant’s fee Site engineer’s fee 18

Phasing -

• The necessity to bring facilities into use as quickly as possible for operational reasons.

• The necessity to split a major project into a smaller units as a contractual consideration

• The necessity of having certain departments ready before others

• Limitation on availability of capital funds

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Commissioning-

• Formation of commissioning team Hospital consultant Hospital administrator Clinical Department Managers Senior nurses Supplies officer Others

• Activities- Bring the hospital building, plant and equipment to a state of the

operational readiness Development operational system Testing of equipment Coordinate training of staff Ensure good communication

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Conclusion-

• Technology requirement must be met

• Clinical needs must be considered• Safety is a major factor• Standards and Guidelines are

essential• Importance of the role of Hospital

Staff in construction and design.

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THANK YOUA hospital is a living organism, made up

of many different parts, having different functions, but all these must be in due proportion and relation to each other and to the environment to produce desired result. – Dr. S. Billings

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