HOSPITAL DESIGNING & PLANNING

DR. D .H. SUKHWAL

Aim

To build a hospital that is

functional, efficient and yet economical without compromising on the design aspect

Objectives
Provide a functional design that

ensures efficient, safe and appropriate work space. Accommodate technical requirements for highly sophisticated equipment. Create clear, segregated paths for movement of people and material within the building.
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Objectives..
Create a humane environment for

patients and staff. Develop building systems that can accommodate rapid change. Blend technical and functional requirements into a design that brings delight to those who use the building 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 with

consideration of landscape, facility mix, bed mix, availability of utilities in the vicinity Inputs from other agencies like airconditioning, electrical, plumbing, etc. required to finalize the working plan for the building
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Inputs from the equipment vendors

especially in specialty areas like Cathlabs, CT-scanners, MRI, linear accelerators, operation theatres etc. essential Emphasis to be given to support services like kitchen, laundry, CSSD, back-up electricity Should be properly planned: Vital services with high capital costs & recurrent expenses
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Planning & Design Team

Functional complexities in hospitals

are more than physical complexities; so we require persons who understand not only the work process of individual departments but those of the hospital operating system as a whole
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Planning & Design Team ..

Required: analysis of functional

needs, understand interrelationship of departments, area requirements, major equipment, the grouping of accommodation and the main outline 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 8001200 sq. ft per bed
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FUNCTIONAL PLANNING

Functionality is a prime determinant of operational efficiency in the total life cycle cost of all hospital structures
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functional planner takes care of..

Functions Staffing pattern Locations Space requirements Relationship Work flow Utilization Functional planner is a trained hospital administrator who is capable of interpreting complex relationships, internal traffic flows (personnel and supplies)
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 A functional design: promotes skill, economy, conveniences & comforts. A nonfunctional design: impedes activities of all types, detracts from quality of care & raises costs
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Functional planner also takes care of.. Technological requirements Operational procedures Product of beauty Reasonable cost Optimal utility

functional planner

With Architect : Physical evaluation of existing facilities Space programming Master site planning Functional evaluation of existing facilities Preparation of workload projections Functional programming
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Physical evaluation of existing facilities

This is a study to determine the degree of physical obsolescence

of existing facilities and to identify major code violations and physical problems and to project future usability.
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Space programming
Based on functional program amended &

approved by hospital a room by room listing is made of all areas in proposed project Net square footage is assigned to each space, & totals accumulated for every department 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 for entire project

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 Here we define functional problems (that

Functional evaluation of existing facilities

detract from operational efficiency, quality of patient care, and convenience of building inhabitants); to evaluate traffic flows & physical relationships to determine space insufficiencies in terms of current requirements to study need for modernization, alterations & expansion, according to strategic plan findings to note possible alternative future uses of structure as a whole as well as of various departmental areas
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Preparation of workload projections

Functional planner determines &

formulates concepts of operation for proposed project according to previous study findings. These concepts are incorporated in functional program These projections form the basis for functional programming, revenue projections & staffing estimates
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Functional programming
Formulating recommendations for operational

concepts Detailed room composition of project, required phasing, alterations, internal & external traffic flows, interdepartmental relationships & operating systems Using approved recommendations & findings of strategic plan, findings of physical & functional evaluations & workload projections, functional planner formulates the activity
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Architects brief
Written program explaining the

above requirements With this written programs help, architect prepares schematic drawings and sketch plans Helps the architect to build a functional, economical and efficient hospital.
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Architects brief contains ..

Permission required from various

regulatory bodies Spatial needs of various departments Manpower required Special requirements of various departments Inter and intra departmental relationships
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Issues that need to be addressed

Flexibility for future expansion Larger secondary areas for better

patient comfort Proper utilities for waiting areas Nurse stations Storage Changing rooms
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issues

Alcoves for stretchers/ wheelchairs Adequate transport facilities Parking facilities Proper light and ventilation Time & trouble spent during this stage will be well repaid & enable whole project to proceed smoothly with minimum subsequent revision
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Market survey
To primarily know the deficiencies in the

health care market, so that we can decide proper facility & bed mix To help us finalize size of the project For existing hospitals to undertake benchmarking in areas like tariff rationalization, compensation policies, utilization reviews for various services etc.
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Market survey.. Of..

Households Medical professionals Diagnostic centers Nursing homes Hospitals Relevant data from census report, demographic surveys, government/ media publications etc.
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Feasibility Reports
Brief description on major findings of

market research Proposed facilities plan Detailed project cost: land & building, medical & non-medical equipment, furniture & fixtures, utilities, pr-operative costs, contingencies, working capital requirement, means of finance
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Feasibility...
Income and expenditure projections

based on the feedback from the market research and available database Profit and Loss/ Balance sheet/Cash flow statements Break even analysis Sensitivity analysis
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Specialized healthcare architecture Healthcare architecture requires specialized knowledge on part of architect & supporting engineering team Stringent functional demands Improves quality of environment for patient & caregivers Meets needs of people using such facilities in times of uncertainty, stress, & dependency on doctors & nurses
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Specialized healthcare architecture..

Recognize & support patients' families &

friends by providing pleasant spaces Project an underlying reassurance that patient is in hands of competent medical staff & in a technically sound healthcare facility Convenience, caring encounters, service orientation and quality of care
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Project Management
Liaison with all Agencies -

Architects/contractors/equipment vendors/utility service consultants and suppliers Monitoring Project with PERT/CPM Managing Change in Project Plans - most vital & complicated component due to various fall outs from change in project design Managing equipment planning schedule including cost-feature analysis, procurement process, installation etc.
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Project Management..
Architectural Designing Project Management Turn Around Strategies
Operational Audits: o Improvement of the lab services o Operation theatre utilization reviews o Manpower audits o Medical audits o Infection control programs o Reorganization of profit centers o Support service audits etc.
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Project Management..
Costing of Services Systems Study & Re-design Manpower Audit & Training Marketing Strategies Biomedical Equipment -

Planning & Procurement Norms

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Product Development
Benchmarking regarding market expectation

from a hospital management system Hospital best practices Reviews of newer modules and upgrade versions and provide recommendation of any enhancements/modification Periodic comprehensive review and study of the existing modules to update and upgrade continuously
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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 business partner
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Good planning is critical to the hospitAls success

If a hospital has to be successful it must be built on bedrock of three

sound principles namely: good planning, good design & construction good management
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Efficient, Functional and economical hospital real test of any hospital is: quality of healthcare it provides minor defects in designing could make operation 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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Efficient, Functional and economicAl hospitAl

The initial cost of building a hospital

is insignificant when compared to the cost of running and maintaining it over the yearsby one reckoning eighteen to twenty times over a period of twenty years
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Efficient, Functional and economical hospital..

Another study says that running cost of a

hospital over 4 to 5 years from the date of completion is about the same as the capital cost if the facilities are not planned & designed properly the intangible cost can be enormous efficiency with which physicians & their assistants can function is greatly handicapped by obsolete design
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efficient, functionAl And economicAl hospitAl

Patient comfort & provision for expansion is often

overlooked. Growing efficiency & innovative ideas have revolutionized hospital building construction to meet special needs of patients

A pleasant environment that makes for enthusiastic & more productive staff also benefits patients indirectly

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efficient, functionAl And economicAl hospitAl

Many patients complain that hospitals

reduce privacy, individuality & more importantly human dignity. Many of these details & facilities can be incorporated 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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efficient, functionAl And economicAl hospitAl

These factors are again influenced by rapid changes and advances that are taking place in fields of technology & medicine & constant need to modernize, renovate, replace & expand healthcare facilities
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Process of planning
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 department to decide; LOCATION of each department, requirement of FLOOR SPACE, intradepartmental &

interdepartmental RELATIONSHIPS, CIRCULATION, TRAFFIC FLOW and requirements IN RELATION TO equipment, personnel & patients
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Operational & Functional planning first Operational planning is a written document for any architectural project:- Services, number of beds, departmental functions, departmental needs, major equipment, space requirements, required personnel, relationships and adjacencies are included here. Dept-by dept description of needed space current and projected needs within the facility
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Operational & Functional planning first

Normally there is either no briefing of the

architects 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 the requirements of hospital & not the other way round
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Key to Functional planning

The proper sequence is; First: Develop operational planning that

defines major requirements & needs. Next: Operational plan is developed into a functional plan i.e. planning of the hospital on a functional basis-that lists every room & suggests net sizes for major functional rooms &total size of the department.
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Mistakes in planning may prove costly

Functional grouping of high traffic areas such as X-ray, laboratories, surgical & delivery suites, physical therapy & clinics on two floors is desirable It permits concentration of hospital activities in a manageable unit. When future expansion or change becomes necessary, they can be accomplished without disturbing other areas
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 Operational Plan & Functional Plan

must 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 for future

A fundamental rule is; hospital should be

planned for at least 10 to 15 years ahead or else plans will be obsolete Well planned systems must be built to keep pace with the changes `Smart` hospitals that respond to present needs while anticipating future change; should be built
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hospitAls must be plAnned for future

All departments are planned in such a way that

they 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 & fixed equipment such as plants & elevators are not located at free ends of the departments as they would permanently block expansion plans
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Space Plan

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design follows function

Architect finalizes his plans, with help of; personal interviews with hospital administrators

experienced in building hospitals literature review

For a 100 bedded hospital, total space area including the parking space, HVAC & water is 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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Ground Floor
Key Departments like OPD, Emergency, Radiology, Laboratory should be on the ground floor. Radiology dept. should be near Emergency dept. 40% of cases

coming to Emergency require X rays

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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 dumb waiters 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

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